REVIEW  PEDIATRIC UPPER LIMB FRACTURE 

Minerva Orthopedics 2021 February;72(1):59-70

DOI: 10.23736/S2784-8469.20.04054-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Monteggia fractures in children: a rapid review of injury mechanisms, diagnosis and treatment

Stefan HUHNSTOCK ¹ ✉, Hilde STRØMME ², Joachim HORN ^{1, 3}

¹ Department for Children’s Orthopedics and Reconstructive Surgery, Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; ² Library of Medicine and Science, University of Oslo, Oslo, Norway; ³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway

INTODUCTION: Monteggia fractures are complex forearm injuries defined by ulna fractures or bowing deformities with concomitant radial head displacement. Even though it is a rare fracture-dislocation pattern, challenges in diagnosis and treatment have led to a considerable research interest with numerous publications. The purpose of this review was to give a consistent overview of the existing knowledge concerning injury mechanisms, diagnosis and treatment.
EVIDENCE ACQUISITION: This rapid review utilized methods in adherence to systematic reviews. According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search of 4 databases was conducted in August 2020 to identify published literature in the period 2010-2020 investigating Monteggia fractures in children. Two reviewers independently applied the selection criteria, according to a priori established screening protocol. Data extraction and assessment of the methodological quality of included studies was done by one reviewer.
EVIDENCE SYNTHESIS: A total of 93 publications were included in the qualitative synthesis. Main findings were: 1) Monteggia fractures occur with different ulna fracture patterns and multidirectional radial head dislocations depending on the injury mechanism. In pediatric patients, anterior and lateral dislocations are most common; 2) diagnosis at time of injury can be challenging, and especially the radial head displacement can easily be missed in a pediatric acute setting with only subtle radiographic changes evident; 3) adequate treatment in the acute phase warrants good clinical outcomes in most of the cases; and 4) the missed diagnosis of radial head dislocations leads to serious sequelae with the need for complex surgical reconstructions. There is to date no defined gold standard treatment of chronic Monteggia fractures.
CONCLUSIONS: Monteggia’s fractures remain complex forearm injuries posing challenges especially in the early diagnosis and treatment if the diagnosis is missed initially.

KEY WORDS: Monteggia’s fracture; Forearm injuries; Elbow joint; Joint dislocations; Joint instability