Monteggia injuries are uncommon but involve severe elbow trauma with various injury patterns. Treatment approaches for these injuries remain contentious and vary significantly. This narrative review focuses on the posterior interosseous nerve in Monteggia injuries, aiming to elucidate the incidence of nerve injuries, assess nerve outcomes, and explore associated complications. We initially reviewed 642 publications and included 20 retrospective studies, which comprised 5 case reports and 15 randomized control trials. Patients were predominantly classified using the Bado classification system, with 83.66% having Bado type I fractures, 9.52% type II fractures, 6.10% type III fractures, and 0.72% type IV fractures. The average age of the patient population was 23 years. Common complications include ulna non-union and limited range of motion, while injuries to the medial nerve and the posterior interosseous nerve are among the most debilitating. Meta-analysis indicates a recovery period of 12-24 weeks following nerve corrective interventions. Further biomechanical and clinical research is needed to better understand the factors influencing nerve and associated recovery.