Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, BŸrkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Arch Orthop Trauma Surg. 2023 Jul;143(7):4085-4093. doi: 10.1007/s00402-022-04576-1. Epub 2022 Sep 3.
Monteggia injuries are rare, but severe injuries of the elbow including various injury patterns. Treatment of these injuries is still topic of debate and strategies differ widely. In this systematic review on Monteggia injuries in adults, we aimed to clarify the incidence of different injury patterns within Monteggia injuries, investigate the main reasons leading to revision surgery and explore which surgical treatments should be favored to achieve satisfactory clinical results.We initially identified 182 publications and ultimately included 17 retrospective studies comprising 651 cases. All patients were classified using the Bado classification, leading to 30.5% Bado type I fractures, 60.4% type II fractures, 5.1% type III and 3.1% type IV fractures. Mean revision rate was 23%. Ulna non-union (28%) and limited range-of-motion (22%) are the main reasons for revision surgery. Meta-analysis shows a trend toward the use of locking plates for ulna fixation which may lead to less revision surgery and fewer ulna non-unions. Further biomechanical and clinical research is necessary to clarify the role of radial head surgery.
孟氏骨折较为少见，但肘部的严重损伤包括多种不同的损伤类型。这些损伤的治疗仍然存在争议，治疗策略差异很大。在本次对成人孟氏骨折的系统回顾中，我们旨在阐明孟氏骨折中不同损伤类型的发生率，调查导致翻修手术的主要原因，并探讨哪些手术治疗方法更有利于获得满意的临床效果。我们最初确定了 182 篇文献，最终纳入了 17 项回顾性研究，共包含 651 例病例。所有患者均采用 Bado 分类进行分类，导致 30.5%为 Bado Ⅰ型骨折，60.4%为 Bado Ⅱ型骨折，5.1%为 Bado Ⅲ型骨折，3.1%为 Bado Ⅳ型骨折。平均翻修率为 23%。尺骨不愈合（28%）和活动范围受限（22%）是翻修手术的主要原因。荟萃分析显示，锁定钢板固定尺骨的应用趋势可能导致更少的翻修手术和更少的尺骨不愈合。需要进一步的生物力学和临床研究来阐明桡骨头手术的作用。
