Table 3.
Overview surgical information of the included outcome studies on chronic Monteggia fracture-dislocation in children.
| Study | Procedure | Approach | Ulnar osteotomy site | Type of ulnar osteotomy fixation | Transcapitellar wire | Annular ligament reconstruction / repair | Type of ulnar correction | Bone grafting | Post-operative cast |
|---|---|---|---|---|---|---|---|---|---|
| Bor4 | UO + CR + gradual lengthening with EF | Directly over osteotomy site | Proximal methaphysis | Single half ring hinged Ilizarov EF (2 proximal + 2 distal threaded pins) Mean time in frame 3.5 mo (2.75-4.5 mo) |
No | No | Dorsal osteotomy + gradual angulation (mean 26° (20-35°) and lengthening (mean 2cm (1.6-2.5cm) in Ilizarov frame (after latency of 1 week) | No | NR |
| Kosev5 | UO + OR | Boyd | Proximal ulna (5cm below olecranon) | prebent one-third tubular plate | No | Repositioning RH in intact AL (2) | Transverse distraction and angulation osteotomy guided by RH reduction stability | Wedge-shaped tricortical bone graft | 4-6 weeks LAE |
| Di Gennaro6 | OR + ALR (repair (7) / Bell Tawse (2)) (+ TP (8)) Or UO + gradual lengthening with EF (9) (+ OR (8) + ALR (8) + TP (6) at time EF removal) Or UO + gradual lengthening with EF + OR + Radial neck osteotomy + ALR + TP (1) Or OR + UO + plate + ALR (Bell Tawse) (2) Or Radial head excision (1) |
Kocher | Middle third ulna (5) Between proximal and middle third (3) Between middle and distal third (1) Proximal third (3) |
External fixator (10) /plate (2) | Yes - Kirschner wire (16) | Repair (16) / Bell Tawse (4) | Posterior bending elongation and angulation osteotomy (+gradual lengthening and angulation using EF (10)/ plate (2)) | Yes (2) < Dalayed union* | ± 4 weeks LAE, 90° elbow flexion + neutral rotation (19) / none (2) |
| Megahed7 | OR + UO + ALR + TP (+ temporary oblique radioulnar pin) | Boyd + dorsal approach | Proximal ulna ("i.e., the site of malunion orplastic deformity") |
Dynamic compression plate or reconstruction plate | Yes- Kirschner wire (16) | Repair / reconstruction with lateral slip triceps | Sagittal oriented V-shaped lengthening (mean 7mm (5-10)) and angulation osteotomy guided by RH reduction stability | No | 6 weeks LAE, 90° elbow flexion + full supination |
| Lu8 | OR (+ reduction in innate AL after dissection) (5) or in case of residual RH-instability OR (+ reduction in innate AL after dissection) + UO (18) |
Anterior Henry approach | Proximal ulna | Plate | Yes – Kirschner wire (1) (removal at 3 weeks) | Repostioning RH in innate AL (20) Repair (3) |
NR | NR | 3 weeks LAE, 90° elbow flexion + neutral rotation |
| Park9 | OR (5) UO + OR (17) |
Kocher approach | Site of maximum deformity / proximal third of the ulna if no apparent deformity | Bent plate | NR | Repair / resection | Corrective/ dorsal angulation osteotomy guided by RH reduction stability | No | 6 weeks LAE, 90° elbow flexion + neutral rotation |
| Xu10 | OR + CORA-based UO | Boyd + directly over pre-determinded CORA | CORA | Bent 5- or 6-hole reconstruction plate | No | No | Transverse dorsal open wedge angulation (mean 15.8° (13-20°)) osteotomy guided by RH reduction stability | No | 6 weeks LAE |
| Ngoc Hung11 | OR + UO + ALR + TP (+ temporary oblique radioulnar pin) | Boyd + dorsal approach | Proximal diaphyseal-metaphyseal junction | Pre-bent one third tubular | Yes - Kirschner wire (removal at 2 weeks) | Fascia lata | Straight distraction (mean 0.86 cm (0.5-1.8 cm)) and angulation (mean 21.3° (16-25°)) osteotomy | Yes (1) < Nonunion* | 6 weeks LAE, 90° elbow flexion + supination |
| Agarwal12 | OR + UO (+ TP) | Kocher | Site of malunion or proximal metaphysis | Dynamic compression plate or reconstruction plate | Yes - Kirschner wire (1) (removal at 3 weeks) | No | Oblique angulation (mean 16.2° (range 10–30°)) and distraction (mean 6.9mm (range 4–15mm)) osteotomy | NR | 6 weeks LAE, 90° elbow flexion + neutral rotation |
| Chen13 | OR + UO (+ TP) (18) Or OR + OU + radial shaft shortening osteotomy (+ TP) (2) |
Kocher + medial directly over proximal ulna | Proximal diaphyseal-metaphyseal junction of ulna | Pre-bent four-to five-hole compression plate | Yes (5) – K-wire (removal at 4 weeks) | No | Dorsal angulation (mean angle 18.9° (range 8-33°)) and elongation (mean 5.6mm (range 0.1-16.9mm)) osteotomy | Bone substitute or allograft if substantial gap | 6 weeks LAE, 90° elbow flexion + full supination |
| Eamsobhana14 | OR + UO (8) or OR + UO + ALR (+ TP) (22) |
Extended posterolateral reaching to midshaft ulna | Proximal ulna | Four-to seven hole compression plate | Yes – 2mm Kirschner wire (7) (removal at 6 weeks) | Triceps fascia (22) – No (8) | Transverse overcorrection osteotomy guided by RH reduction stability | No | 6 weeks LAE, 90° elbow flexion + supination |
| Stragier15 | OR + UO (+ TP) (12) or OR + UO + ALR +TP (2) |
Kaplan (13) – Extended Kocher (1) | Proximal ulna (5 cm below olecranon) | Plate and screws | Yes 1.6mm Kirschner wire (12) (removal at 4-6 weeks) | Bell Tawse (1) / repair (1) | Dorsal opening wedge osteotomy guided by RH reduction stability | Autologous bone graft (2) | 4-6 weeks LAE, 90° elbow flexion + neutral rotation |
| Take16 | OR + UO | Boyd + directly over proximal ulna | Proximal ulna | Ilizarov mini-EF Mean time in EF 10w (8-13w) |
No | No | Opening wedge angulation osteotomy | No | NR |
| Mazhar17 | OR + UO + ALR (+ TP) | Kocher | Proximal ulnar metaphysis | 3.5mm reconstruction plate | Yes (1) | Repair (5) / reconstruction with triceps fascia (2) | Angulation and distraction osteotomy guided by RH reduction stability | NR | 2 weeks LAE, 90° elbow flexion + neutral rotation |
| He18 | OR + cast (1) Or OR + UO (10) or OR + UO + ALR (6) |
NR | NR | LCP (15) / EF (1) | NR | Repair (5) / reconstruction (1) | NR | NR | NR |
| Wang19 | OR + temporary-EF-assisted UO (+ TP) | Boyd (3) – Henry approach with proximal ulnar dorsal incision (10) | Proximal ulna | Temporary unilateral external fixator (2 proximal and 2 distal Kirschner wires) + 2.7mm LCP | Yes – Kirschner wire (1) | No | Oblique osteotomy with posterior (Bado type I)/posteromedial (Bado type III) angulation (mean 28° (20-30°)) and lenghtening (mean 0.7mm (0.5 – 1.2mm)) guided by RH reduction stability | ‘Allograft bone graft substitute’ | 6 weeks LAE, 90° elbow flexion + supination |
| Gallone20 | UO + gradual distraction and angulation using EF until RH reduction is obtained (9) + UPON failure to achieve reduction at time of EF removal: + OR + ALR + TP (11) |
Directly over osteotomy site / Kocher (OR) | Site of maximum deformity / as proximally as possible / proximal third | External fixator, 2 proximal and 2 distal pins | Yes - Kirschner (11) (removal at 2-3 weeks) | Repair (7) / Bell Tawse (4) | Linear distraction (1mm/ day from day 3 PO onward, mean 11mm (3-37mm)) and angulation (mean correction 16°) osteotomy with EF | Yes < aseptic nonunion* (3) | 3 weeks once EF was removed |
| Liao21 | OR + UO (+ TP) | Anterior Henry’s + posterior approach | Proximal ulna | Bent plate (removal when clinical and radiographic evidence of union (6-12 mo)) | Yes - Kirschner wire (10) | No | Transverse dorsal angulation and lengthening osteotomy guided by RH reduction stability | Iliac graft 'if necessary' | 4-6 weeks LAE, 90° elbow flexion + neutral rotation or mild supination |
| Soni22 | UO + OR + temporary TP | Extended lateral approach | Proximal ulna | Straight plate (2,7-3,5mm) | Yes – temporary during surgery | No | Transverse angulation and lengthening osteotomy guided by RH reduction stability | NR | 4 weeks LAE, 90° elbow flexion + neutral rotation |
| Kumar23 | OR + UO + ALR | Boyd approach | Apex of the deformity | Pre-bent 3.5mm 5-hole dynamic compression plate | No | Bell Tawse | Dorsal angulation (10-30°) open wedge osteotomy (no lengthening or distraction) | No | 5 weeks LAE, 90° elbow flexion + neutral rotation |
| Yuan24 | UO + CR (adjustment EF until stable reduction RH) (5) or UPON failure to reduce RH UO + OR (+ALR) (6) |
Posterior approach + modified Kocher (OR) | Proximal ulna | EF (5-6 pins, 2 or 3 proximal and 2 distal of the osteotomy) | NR | Repair if possible | Transverse lengthening and dorsal angulation (mean 25.6 ±7.7) osteotomy | NR | None |
| Musikachart25 | OR + UO (overcorrection (10 ) / anatomical (11)) (+ ALR + TP) | Extended lateral approach | Proximal ulna | Plate and screws | Yes – 2mm Kirschner wire (removal at 6 weeks) | Triceps fascia (8) – No (13) | Transverse overcorrection (10) (mean 28.37° (12-40°)) osteotomy (10) OR correction (mean 6.09° (3-9°)) osteotomy (11) | NR | 6 weeks over the elbow, 90° flexion + supination |
| Çevi̇k26 | OR + UO (plate) + TP + ALR (6) Or UO (cross k-wire) + CR + TP (5) \ or OR + UO (intramedullary k-wire) + TP + "radial head fixation with k-wire" (2) Or UO (plate) + CR (5) |
Not specified | Junction proximal third and distal two thirds of the ulna or fracture site if no bony bridging | Plate (11) – Crossed k-wire (5) – intramedullary k-wire (2) | Yes - Kirschner wire (13) (removal at 6 weeks) | Yes (6) – technique not specified | Overcorrection osteotomy guided by RH reduction stability | No | 6 weeks LAE (in case of TP) |
NR (=Not Reported), RH (=Radial Head), AL (=Annular Ligament), LAE (=Long Above Elbow cast), EF (External Fixator), CORA (=Center Of Rotation Angulation) [Open Reduction (OR), Closed Reduction (CR), Ulnar Osteotomy (UO), Annular Ligament Repair/Reconstruction (ALR), Transcapitellar Pinning (TP)]
*postoperative complication