The Surgical Management of Missed Paediatric Monteggia Fractures: A Systematic Review and Meta-Analysis

OBJECTIVES: The review aims to pool together the different surgical managements and outcomes of missed paediatric Monteggia fractures.

DATA SOURCES: A systematic review was conducted using PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and The Cochrane Library from inception through 02 March 2020. The keywords were "Monteggia fracture", "missed Monteggia", "neglected Monteggia", "chronic Monteggia" and "chronic radial head dislocation".

STUDY SELECTION: All original human studies on missed paediatric Monteggia fractures were included. Congenital Monteggia fractures and isolated radial head dislocations were excluded.

DATA EXTRACTION: The revised Methodological Index for Non-Randomised Studies tool was used to assess the quality of studies.

DATA SYNTHESIS: Each patient's data was retrieved individually. Chi-square test and Fisher's exact test were used to analyse the difference in outcomes for different surgical managements. Multivariate analysis was performed for variables that were significant on univariate analysis.

CONCLUSIONS: 30 studies with 600 patients were included. Proximal ulnar osteotomies (p = 0.016) and the absence of transcapitellar pinning (p = 0.001) were the most significant predictors for eventual reduction of radial head. Other surgical management variables were not significant predictors. These include open or closed reduction, approach of radial head reduction, presence or absence of ulnar osteotomy, presence or absence of lengthening, angular correction, overcorrection or bone grafting of ulnar osteotomy, type of fixation for ulnar osteotomy, presence or absence of radial osteotomy, presence or absence of annular ligament repair or reconstruction and repair or reconstruction of annular ligament.

LEVEL OF EVIDENCE: Level IV. See Instructions for Authors for a complete description of levels of evidence.