Surgical and Nonsurgical Treatment of Pediatric Monteggia Fractures: A Systematic Review

There remains controversy surrounding the treatment of pediatric Monteggia fractures. This systematic review examines the existing literature with the aim to elucidate optimal management strategies.

A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. All data collection was completed by May 27, 2024.

Thirteen studies were included, with three evaluating only surgical techniques, two evaluating only conservative techniques, and eight evaluating surgical versus conservative treatment. The mean Quality Appraisal Tool rating of all the studies was 63.4%, with five level III and eight level IV studies. There were 696 cases, with an average age of 6.6 years (range: 11 months-18 years), with 375 Bado Type 1, 31 Bado Type 2, 193 Bado Type 3, and 32 Bado Type 4 fractures. Overall outcomes were generally good for both conservatively and surgically treated fractures. The most frequently reported indication for surgery was failure of conservative treatment. There was a 6.0% complication rate and a 14.6% complication rate for conservative and surgical treatment, respectively.

Although there is still no consensus on the treatment of pediatric Monteggia fractures, both operative and nonoperative approaches result in good outcomes with expeditious treatment.

(1)Standardized treatment of pediatric Monteggia fractures remains elusive.(2)Whereas surgeons agree that early diagnosis and expeditious treatment are essential, it remains unclear whether an initial trial of conservative treatment or immediate surgical intervention is indicated.(3)More stable fracture patterns tend to do well with a conservative approach, and there tend to be more complications with surgery.(4)More research is necessary to determine if there is a true difference in healing outcomes between the two treatment options.

Level IV-therapeutic.