Comparative Analysis: Operative versus Non-Operative Management of Acute-Pediatric Monteggia Fractures

IF 2.3 4区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of the National Medical Association Pub Date : 2025-09-01 DOI:10.1016/j.jnma.2025.08.059

Lakin S. Hatcher BA, Vidushan Nadarajah MD, Anh Le BA, Ryan Garay BA, Sarah Dance BA, Sean Tabaie MD

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引用次数: 0

Abstract

Background

The management of acute pediatric Monteggia fractures, characterized by a fracture of the ulna with associated radial head dislocation, remains a challenging aspect of pediatric orthopedic care. The primary debate centers around the efficacy of operative versus non-operative treatments. This systematic review aims to provide a comprehensive comparison of these approaches, focusing particularly on the outcomes and effectiveness of intramedullary fixation versus plate fixation within operative treatments.

Methods

A systematic review was conducted following PRISMA guidelines, involving an extensive search of databases including PubMed, Embase, and Cochrane Library up to May 2024. Studies included in the review had to meet specific criteria: they had to involve pediatric patients (age <18 years) with acute Monteggia fractures, compare operative to non-operative management, and report on outcomes such as complication rates, recovery of range of motion (ROM), and need for further interventions. Data extraction covered study characteristics, participant demographics, fracture patterns, intervention details, and outcomes. Quality assessment of the included studies was performed using the MINORS (Methodological Index for Non-Randomized Studies) tool.

Results

A total of 24 studies were included in the qualitative synthesis, with 15 studies providing quantitative data for meta-analysis. The non- operative approach, typically involving closed reduction and casting, was found to be effective for certain fracture patterns but required close monitoring due to the risk of redislocation, especially in Bado Type III and IV fractures. Studies highlighted that non-operative treatment had a comparable outcome to surgical management when careful follow-up was ensured.

In contrast, surgical management showed a higher initial success rate, with intramedullary fixation (IMF) being preferred for its minimally invasive nature and reliable stabilization. IMF was associated with fewer immediate complications, such as infection and nerve injury, and allowed for early mobilization. Plate fixation, while less commonly used, provided superior outcomes in complex fractures, particularly in maintaining reduction and promoting bone healing. This method was noted for its robustness in cases with high angular deformities or comminution.

Key predictors of treatment success included the type and degree of fracture angulation, timing of intervention (with earlier treatment yielding better outcomes), and the presence of associated injuries or comorbidities. The review found that patients undergoing operative treatment had a faster return to full ROM and lower rates of redislocation. However, surgical management also came with risks such as hardware complications and the need for subsequent surgical removal in cases of IMF.

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小儿急性蒙氏骨折手术与非手术治疗的比较分析

背景：以尺骨骨折合并桡骨头脱位为特征的急性小儿Monteggia骨折的处理仍然是儿科骨科护理的一个具有挑战性的方面。主要的争论集中在手术与非手术治疗的疗效上。本系统综述旨在对这些方法进行全面比较，特别关注髓内固定与钢板固定在手术治疗中的效果和有效性。方法按照PRISMA指南进行系统评价，包括广泛检索PubMed、Embase和Cochrane Library等数据库，检索截止到2024年5月。纳入本综述的研究必须符合特定的标准：它们必须涉及急性蒙氏骨折的儿科患者（18岁），比较手术与非手术治疗，并报告并发症发生率、活动范围恢复（ROM）和进一步干预的需要等结果。数据提取包括研究特征、参与者人口统计、骨折模式、干预细节和结果。使用未成年人（非随机研究方法学指数）工具对纳入的研究进行质量评估。结果定性综合共纳入24项研究，其中15项研究提供定量数据进行meta分析。非手术入路，通常包括闭合复位和铸造，被发现对某些骨折类型有效，但由于再脱位的风险，需要密切监测，特别是在Bado III型和IV型骨折中。研究强调，在确保仔细随访的情况下，非手术治疗与手术治疗的结果相当。相比之下，手术治疗显示出更高的初始成功率，髓内固定（IMF）因其微创性和可靠的稳定性而被首选。IMF与感染和神经损伤等直接并发症较少相关，并允许早期动员。钢板固定虽然不太常用，但在复杂骨折中具有较好的疗效，特别是在维持复位和促进骨愈合方面。该方法以其在高度角度畸形或粉碎情况下的鲁棒性而闻名。治疗成功的关键预测因素包括骨折成角的类型和程度、干预的时机（越早治疗效果越好）以及是否存在相关损伤或合并症。回顾发现，接受手术治疗的患者恢复完全ROM更快，再脱位率更低。然而，手术治疗也有风险，如硬体并发症和在IMF病例中需要后续手术切除。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the National Medical Association 医学-医学：内科

CiteScore

4.80

自引率

3.00%

发文量

139

审稿时长

98 days

期刊介绍： Journal of the National Medical Association, the official journal of the National Medical Association, is a peer-reviewed publication whose purpose is to address medical care disparities of persons of African descent. The Journal of the National Medical Association is focused on specialized clinical research activities related to the health problems of African Americans and other minority groups. Special emphasis is placed on the application of medical science to improve the healthcare of underserved populations both in the United States and abroad. The Journal has the following objectives: (1) to expand the base of original peer-reviewed literature and the quality of that research on the topic of minority health; (2) to provide greater dissemination of this research; (3) to offer appropriate and timely recognition of the significant contributions of physicians who serve these populations; and (4) to promote engagement by member and non-member physicians in the overall goals and objectives of the National Medical Association.