DOI: 10.36347/sjams.2018.v06i10.075

Pages: 4042-4047

Neglected Monteggia lesion is defined as a combination of ulnar fracture and dislocation of the radial head seen at least 4 weeks after the trauma causing it. The treatment of these lesions represents a challenge and a subject of debate in pediatric traumatology. This is a meta-analysis based on case series published online during the previous 40 years whose objective is: To establish an epidemiological, clinical and radiological profile of patients suffering from this lesion. To specify the techniques used in the management, and to compare their results and their complications. 45 case series were included in our study. The total number of patients in these series was 606. 54.11% of patients were male and 45.89% female. The average age at the time of the trauma was 6.7 years. The lesion concerned the right side in 56.63% and the left side in 43.37%. Radiologically, Bado's classification was the most widely used; 81.65% of the lesions were type I, 11.85% were type III, 4.92% type II, and 1.65% type IV. The average duration between injury and therapeutic care was 13.3 months, 99.3% of patients were treated surgically. The Boyd’s procedure was the most used (54%). Bouyala's operation was performed in more than three quarters of the cases included (76.5%). The average follow-up period in all series was 49.95 months. One in three patients had a postoperative complication (34%), The subluxation of the radial head was the most frequent (24.7% of complications). The comparison of the techniques used in the management of the neglected Monteggia lesion showed that the Bouyala’s procedure without ligamentoplasty provides the best functional result and the lowest complication rate postoperatively.