A Monteggia fracture involves a fracture of the ulna with disruption of the proximal radio-ulnar joint (PRUJ) and radiocapitellar dislocation (Bado, 1967). 2022 Jul 22. - Monteggia Fractures in Children. J Pediatr Orthop. Datta T, Chatterjee N, Pal AK, Das SK. Key words: Monteggia's fracture; Radius fracture; Ulna - posterior Monteggia frx is reduced by applying traction to forearm w/ the forearm in full extension; An Alternative to the Traditional Radiocapitellar Line for Pediatric Forearm Radiograph Assessment in Monteggia Fracture. Six of the eight patients who had an unsatisfactory (fair or poor) result had had a Bado type-II fracture with a concomitant fracture of the radial head. Forearm fractures in children. al. Monteggia fracture-dislocations remain a relatively uncommon injury. The radius and ulna are closely invested by the interosseous membrane, which accounts for the increased risk of displacement or injury to the radius when the ulna fractures. PDF Case Report The MonteggiaFracture: literature review and report of a In a retrospective study on the functional and radiologic long-term outcome of ORIF in 11 skeletally mature patients with Bado type I Monteggia fractures, Guitton et al found that the mean arc of elbow flexion increased from 110 at early follow-up to 120 at late follow-up. [QxMD MEDLINE Link]. (0/7), Level 3 Material and method The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. - reduction: Floriano Putigna, DO, FAAEM Staff Physician, Florida Emergency Physicians, Inc, and Florida Hospital Watson-Jones R. Fracture and Joint injuries. As multiple variants of Monteggia fractures exist, it is most accurately described as a forearm fracture with dislocation of the proximal radioulnar joint.4 Subtle bowing of the ulna shaft with an asssociated radiocapitellar dislocation may be missed by the inexperienced clinician who is looking for a forearm fracture and therefore The radial head dislocation may not be apparent and will possibly be missed if the elbow is not included in the radiograph. plastic deformation of the ulna without obvious fracture, pain, swelling, and deformity about the forearm and elbow, isolated radial head dislocations almost never occur in pediatric patients, a line down the radial shaft should pass through the center of the capitellar ossification center, radial head is stable following reduction, radial head will reduce spontaneously with reduction of the ulna and restoration of ulnar length, for Type I, elbow flexion is the main reduction maneuver, if reduction of radiocapitellar joint is unsuccessful, annular ligament is most common block to reduction, radial head is not stable following reduction, ulnar length is not stable (unable to maintain ulnar length), older patients 10y if closed reduction is not stable, symptomatic individuals (pain, loss of forearm motion, progressive valgus deformity) who had delayed treatment or missed diagnosis, open reduction of radial head through a lateral approach if needed in chronic (>2-3 weeks old) Monteggia fractures where radial head still retains concave structure, annular ligament reconstruction almost never required for acute fractures, Pediatric Pelvis Trauma Radiographic Evaluation, Pediatric Hip Trauma Radiographic Evaluation, Pediatric Knee Trauma Radiographic Evaluation, Pediatric Ankle Trauma Radiographic Evaluation, Distal Humerus Physeal Separation - Pediatric, Proximal Tibia Metaphyseal FX - Pediatric, Chronic Recurrent Multifocal Osteomyelitis (CRMO), Obstetric Brachial Plexopathy (Erb's, Klumpke's Palsy), Anterolateral Bowing & Congenital Pseudoarthrosis of Tibia, Clubfoot (congenital talipes equinovarus), Flexible Pes Planovalgus (Flexible Flatfoot), Congenital Hallux Varus (Atavistic Great Toe), Cerebral Palsy - Upper Extremity Disorders, Myelodysplasia (myelomeningocele, spinal bifida), Dysplasia Epiphysealis Hemimelica (Trevor's Disease). Are you sure you want to trigger topic in your Anconeus AI algorithm? Monteggia described a fracture of the proximal third of the ulna with anterior dislocation of the radial head from both the proximal radioulnar and radiocapitellar joints. J Bone Joint Surg Am. 4 (2):167-72. The treating physician may reduce an unrecognized dislocation while reducing or immobilizing the ulna fracture. - radial head is gently repositioned by direct manual pressure anteriorly on the bone; - immobilization is continued until there is union of the ulna; [QxMD MEDLINE Link]. Subluxation of the radial head occurred in three patients; one patient experienced transient palsy of the posterior interosseous nerve; and distortion of the radial head (which had no bearing on function) occurred in three. Monteggia fractures are primarily associated with falls on an outstretched hand with forced pronation. Monteggia fracture is characterized by radial head dislocation combined with proximal ulnar fracture. Rockwood CA, Green DP, Bucholz R, eds. - hence dislocation of radial head w/ frx of proximal 1/3 of ulna is known as Monteggia's deformity. A 12-year-old male sustains an ulnar fracture with an associated posterior-lateral radial head dislocation. What is the most likely finding? The ulna was fixed with a tension band-wire construct supplemented with screws in three patients (all of whom had a Bado type-II fracture). 7th ed. 2015. Although most pediatric fracture patterns can be managed conservatively with closed reduction and long arm casting, most adult fractures require open reduction and internal fixation (ORIF). Monteggia fracture - fracture of the proximal 1/3 of the ulnar shaft accompanied by the dislocation of the radial head. Scary Elbows: The Proximal Monteggia with David Stanley | OTS, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Monteggia Injury: Case of the Week - Joanne Wang, MD, 2016 Current Solutions in Orthopaedic Trauma, Case Presentation: Chronic Monteggia Fx / Ulnar Nonunion. Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna. 2020 Oct 1. - paralysis of deep branch of radial nerve is most common; - Giovanni Monteggia (1814) first described frx of proximal 1/3 of ulna in association w/ [QxMD MEDLINE Link]. (0/1), Level 2 of flexion for 6 weeks; - Delayed Dx: (0/8), Level 1 J Orthop Trauma. What preoperative planning is required for surgical treatment of. [Full Text]. When the ulna is fractured, energy is transmitted along the interosseous membrane, displacing the proximal radius. TraumaMonteggia Fractures - The Orthobullets Podcast - Podcast [QxMD MEDLINE Link]. hyperextension theory; - Type I (or extension type) - 60% of cases: Are you sure you want to trigger topic in your Anconeus AI algorithm? Late reconstruction of chronic Monteggia lesions in children can be complicated and unpredictable. Waters PM, Bae DS, eds. A review of the complications, Does a Monteggia variant lesion result in a poor functional outcome? Bado type II lesion after open reduction and internal fixation. Bruce HE, Harvey JP, Wilson JC Jr. Monteggia fractures. Compartment Syndrome in Operatively Managed Pediatric Monteggia Fractures and Equivalents. Advances in radiography and fracture research have helped define, classify, and guide operative management. [5] The mean arc of forearm rotation increased from 145 to 149. - line drawn thru radial shaft and radial head should align w/ capitellum in any position if the radial head is in normal position What are Monteggia fractures and how are they classified and treated? The ulna and interosseous membrane also may provide stable platforms for dislocation of the proximal radius, leading to the Monteggia fracture. J Bone Joint Surg Am. [QxMD MEDLINE Link]. The keys to successful diagnosis of a Monteggia fracture are clinical suspicion and radiographs of the entire forearm and elbow. - Giovanni Monteggia (1814) first described frx of proximal 1/3 of ulna in association w/ anterior dislocation of radial head; - hence dislocation of radial head w/ frx of proximal 1/3 of ulna is known as Monteggia's deformity. 2023 Lineage Medical, Inc. All rights reserved, PediatricsMonteggia Fracture - Pediatric. This injury is frequently confused with anterior Monteggia lesions by virtue of the readily apparen It is named after Giovanni Battista Monteggia. (3/76), Level 1 35 (3):e434-7. [QxMD MEDLINE Link]. [14] Osteoarthritic changes were seen at the radiohumeral joint in four patients. for: Medscape. The aim of this study was to evaluate clinical outcomes of surgical treatment of Monteggia variant fracture dislocations with focus on the operative technique and management of associated radial head fractures. 1951 Feb. 33-B (1):65-73. J Bone Joint Surg Am. Adults and unstable injuries generally require ORIF of the ulna. The anular (annular) and radial collateral ligaments stabilize the radial head. (1/1), Level 4 If the elbow is flexed, the chance of a type II or III lesion is greater. A Monteggia fracture-dislocation, or proximal ulnar fracture with associated radial head dislocation, is a complex injury of the forearm and elbow that can destabilize the elbow leading to poor functional outcomes. The present multicenter retrospective study compared results for the Bouyala procedure with versus without plasty of the annular ligament of the radial head in evolved radial head lesion (Monteggia lesion), assessing the benefit of associating ligamentoplasty to ulnar osteotomy. Monteggia Fractures - Trauma - Orthobullets Monteggia Fractures in the pediatric population are defined as proximal ulna fractures or plastic deformation of the ulna with an associated radial head dislocation. - fracture of ulnar metaphysis; This is the most common type of Monteggia fracture. Events Search Events ; All Events List All Events Calendar Trauma Spine Shoulder & Elbow Knee & Sports Pediatrics Recon Hand . Monteggia fractures in children and adults. Indications for treatment of Monteggia fractures (seeTreatment) are based on the specific fracture pattern and the age of the patient (ie, pediatric or adult). Once the cast is hardened, mark it, then split using an oscillating saw, a hand saw, or a sharp plaster knife (1). Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). Curr Opin Pediatr. Floriano Putigna, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Osteopathic AssociationDisclosure: Nothing to disclose. Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIzMTQzOC1vdmVydmlldw==, Type I - Fracture of the proximal or middle third of the ulna with anterior dislocation of the radial head (see the first and second images below), Type II - Fracture of the proximal or middle third of the ulna with posterior dislocation of the radial head (see the third and fourth images below), Type III - Fracture of the ulnar metaphysis with lateral dislocation of the radial head (see the fifth and sixth images below), Type IV - Fracture of the proximal or middle third of the ulna and radius with anterior dislocation of the radial head (see the seventh image below), Excellent - Union with less than 10 loss of elbow and wrist flexion/extension and less than 25% loss of forearm rotation, Satisfactory - Union with less than 20 loss of elbow and wrist flexion/extension and less than 50% loss of forearm rotation, Unsatisfactory - Union with greater than 30 loss of elbow and wrist flexion/extension and greater than 50% loss of forearm rotation, Failure - Malunion, nonunion, or chronic osteomyelitis. anterior dislocation of radial head; Monteggia fracture - Wikipedia [QxMD MEDLINE Link]. Vol 2: 520. J Pedtiatr Orthop 2016; 35:S67-S70. Monteggia fractures. - Post - Orthobullets Treatment may be closed reduction and casting for length stable ulna fractures with a stable radiocapitellarjoint. Most nerve injuries are neurapraxias and typically resolve over a period of 4-6 months. [2]. A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. 2012 Mar 7. J Pediatr Orthop 2015; 35 (2) 115-120. 36 (2):65-73. - posterior interosseous nerve may be wrapped around neck of radius, preventing reduction; Once the radial head is reduced in closed injuries, surgical treatment may be delayed until the patient is stable and the surgery may be performed in a more elective fashion. 2015 Nov. 31 (4):565-80. Tan SHS, Low JY, Chen H, Tan JYH, Lim AKS, Hui JH. J Clin Diagn Res. (10/80), Level 3 Undecided Penrose considered type II lesions a variation of posterior elbow dislocation. - in child, a dislocated radial head should never be resected, since it will cause cubitus valgus, prominence of distal end of ulna, Tan L, Li YH, Sun DH, Zhu D, Ning SY. [QxMD MEDLINE Link]. [14]. The pediatric Monteggia fracture. - Post - Orthobullets Speed JS, Boyd HB: Treatment of fractures of ulna with dislocation of head ofradius (Monteggia fracture). (0/1), Level 5 1949 Nov. 31B (4):578-88, illust. 2022 Feb 1. 2023 Lineage Medical, Inc. All rights reserved. Unrecognized dislocations may result from reduction of the dislocated radius prior to presentation. [QxMD MEDLINE Link]. Melvin P. Rosenwasser, MD (CSOT #21, 2016), Frontiers in Upper Extremity Surgery - 2016, Monteggia - Alfred W. Hess, MD (Frontiers #16, 2016), Monteggia Fracture Dislocation - Everything You Need To Know - Dr. Nabil Ebraheim, Undecided Injury. Whenever a fracture of a long bone is noted, the joints above and below should be evaluated with radiographs in orthogonal planes (planes at 90 angles to each other). (0/1), Level 1 - medullary nail in this location may not fill the canal and may thus provide less than rigid fixation; [QxMD MEDLINE Link]. Delpont M, Louahem D, Cottalorda J. Monteggia injuries. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Bado [1] classification in Monteggia fracture-dislocations and Monteggia Fracture: Practice Essentials, Anatomy, Pathophysiology (0/1), Level 1 Since Monteggia first described the fracture bearing his name in 1814, the association of radial head dislocation with ipsilateral ulnar fracture has been well described. Splinting of the wrist in extension and finger range-of-motion (ROM) exercises help prevent contractures from developing while the patient awaits resolution of the nerve injury. (OBQ10.240) Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. Modified technique for correction of isolated radial head dislocation without apparent ulnar bowing: a retrospective case study. J Hand Surg Am. This allows the radius to rotate around the ulna. Monteggia Fractures - Trauma - Orthobullets - Plating Techniques Pronation injuries of the forearm, with special reference to the anterior Monteggia fracture. [7] Diagnosis can be made with plain radiographs of the elbow. 2008 Apr. [1] The injury is typically caused by axial loading on a partially flexed metacarpal and may be associated with other carpal bone fractures or ligament injuries. Clin Orthop Relat Res. [11, 12] Of the Monteggia fractures, Bado type I has been reported to be the most common (59%), followed by type III (26%), type II (5%), and type IV (1%). Monteggia Fracture - Orthopedics - Medbullets Step 2/3 Cao YQ, Deng JZ, Zhang Y, Yuan XW, Liu T, Li J, et al. Melvin P. Rosenwasser, MD (CSOT #21, 2016), Frontiers in Upper Extremity Surgery - 2016, Monteggia - Alfred W. Hess, MD (Frontiers #16, 2016), Monteggia Fracture Dislocation - Everything You Need To Know - Dr. Nabil Ebraheim. 2023 Lineage Medical, Inc. All rights reserved. J Bone Joint Surg Br. Acute pediatric Monteggia fractures: A. conservative approach to stabilization. The character of the ulnar fracture is useful in determining optimal treatment. 2009 Jun. Fracture of the upper end of the ulna associated with dislocation of the head of the radius in children. A good radiographic result was seen in all patients who underwent open reduction within 3 years after injury or before reaching 12 years of age. On examination, the affected arm is swollen and tender around his elbow. The distal ulna and radius also articulate at the DRUJ. This is a report of two rare variants of Monteggia fracture-dislocation. [QxMD MEDLINE Link]. Application of this eponym to all injuries with radiocapitellar subluxation or dislocation has led to some confusion. 32 (4):352-6. encoded search term (Monteggia Fracture) and Monteggia Fracture. Monteggia fractures in children and adults. - Post - Orthobullets Robert J Nowinski, DO is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Ohio State Medical Association, Ohio Osteopathic Association, American College of Osteopathic Surgeons, American Osteopathic AssociationDisclosure: Received grant/research funds from Tornier for other; Received honoraria from Tornier for speaking and teaching. Proximal radius dislocations in skeletally immature teenagers and children occur in the setting of a spectrum of ulnar injuries that often do not follow classic adult patterns. Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. Ramski, D., Hennrikus, W., Bae, D., et. Musculoskelet Surg. - ref: Repair of Bado II Monteggia Fracture: Case Presentation and Surgical Technique. Xiao RC, Chan JJ, Cirino CM, Kim JM. Then divide the underlying padding with scissors (2) and remove the protective strip to expose the skin. Monteggia fractures in adults. - Post - Orthobullets Telephone: 410.494.4994. (16/80), Level 5 JAMA 1940;115:1699-1705. Purpose: Monteggia variant defined as Monteggia fracture dislocation with radial head or neck fracture, coronoid fracture, ulnohumeral joint dislocation or combination of these injuries. 1949;31B:578-88. [Full Text]. The close proximity of these nerves may lead to injuries when a Monteggia fracture occurs. Wong JC, Getz CL, Abboud JA. Breaks, Fractures, and Dislocations Center, Association of Medical Consultants of Mumbai, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society. Diagnosis can be made with plain radiographs of the elbow. Problems with the elbow related to fractures of the coronoid process and the radial head, which are common with Bado type-II Monteggia fractures, remain the most challenging elements in the treatment of these injuries. Dhoju D, Parajuli B. Functional Outcome of Pediatric Monteggia Fracture Dislocation Treated Surgically in a Tertiary Care Centre of Nepal. Galezzi's fracture-fracture to the distal radius accompanied by ulnar head dislocation at distal radio-ulna joint. [13] : Pain, nerve dysfunction, and cosmetic deformity are other factors to consider in evaluating the outcome of treatment in Monteggia fracture-dislocations. Children (Basel). - Type III - 20% Murali Poduval, MBBS, MS, DNB Orthopaedic Surgeon, Senior Consultant, and Subject Matter Expert, Tata Consultancy Services, Mumbai, India [QxMD MEDLINE Link]. It is imperative to look for associated injuries of the radial head and coronoid, which alter the management and lead to altered outcomes. [QxMD MEDLINE Link]. Radial Head Fractures and Dislocations Questions & Answers - Medscape Which direction is the radial head most likely dislocated? [QxMD MEDLINE Link]. Bado believed that the type III lesion, the result of a direct lateral force on the elbow, was primarily observed in children. [QxMD MEDLINE Link]. Trauma10531822MonteggiaFracturesAuthor:Tracy JonesIntroductionInjury defined asproximal 1/3 ulnar fracture with associated radial head dislocation/instabilityEpidemiologyrare in adultsmore common in childrenwith peak incidence between 4 and 10 years of agedifferent treatment protocol for childrenAssociated injuriesmay be part of complex injury 2014 Jun. The posterior interosseous branch of the radial nerve, which courses around the neck of the radius, is especially at risk, particularly in Bado type II injuries. Am J Orthop (Belle Mead NJ). Monteggia Fractures in Pediatric and Adult Populations, Clifford R. Wheeless, III, M.D. Treatment may be closed reduction and casting for length stable ulna fractures with a stable radiocapitellar joint. Acta Orthop Belg. The olecranon, midshaft, and distal shaft may be involved. Monteggia described a fracture of the proximal third of the ulna with anterior dislocation of the radial head from both the proximal radioulnar and radiocapitellar joints. - ulnar frx is treated w/ compression plate (esp in proximal third) Monteggia Fracture - Pediatric - Pediatrics - Orthobullets - treated by reduction and stabilization of ulna followed by reduction of radial head via supination & direct pressure; Van Tongel A, Ackerman P, Liekens K, Berghs B. Angulated greenstick fractures of the distal forearm in children: closed reduction by pronation or supination. [7] Interestingly, he described this injury pattern in the pre-Roentgen era solely on the basis of the history of injury and the physical examination findings. Pediatric Monteggia fractures: amulticenter examination of treatment strategy and early clinical and radiographic results. - frx of ulna just distal to coronoid process w/ lateral dislocation of radial head; - Type IV (5%) A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. Proximal ulnar osteotomy in the treatment of neglected childhood Beutel BG. This may occur in the field spontaneously or as a result of manipulation by emergency responders. Events. The ulna and radius are in direct contact with each other only at the PRUJ and the DRUJ; however, they are unified along their entire length by the interosseous membrane. Canton G, Hoxhaj B, Fattori R, Murena L. Annular ligament reconstruction in chronic Monteggia fracture-dislocations in the adult population: indications and surgical technique. Anderson LE, Meyer FN. [QxMD MEDLINE Link]. 2023 Lineage Medical, Inc. All rights reserved. Surgical Management of Missed Pediatric Monteggia Fractures: A Systematic Review and Meta-Analysis. 2013 Jan;44(1):59-66. 2013. The posterior interosseous nerve travels around the neck of the radius and dives under the supinator as it courses into the forearm. J Am. J Pediatr Orthop. Undecided Monteggia-type elbow fractures in childhood. Bennett Fracture - StatPearls - NCBI Bookshelf (0/1), Level 3 Monteggia GB. Chin J Traumatol. Datta et al conducted a prospective, longitudinal study of 21 children with Monteggia fracture with dislocation (18 type I, three type III), all of whom were treated by modified Hirayama corrective osteotomy of the ulna with wedge bone grafting, restoration of bone length, reconstruction of the anular ligament using the Bell Tawse method, and fixation of the radial head with transcapitellar Kirschner wire (K-wire). 2020 Mar. Fractures of the forearm with dislocation of the proximal radioulnar joint are known as Monteggia frac tures26'847. Ring D, Jupiter JB, Waters PM. - spontaneous recovery is usual & exploration is not indicated; - this is esp true on the lateral projection; 2012 Jun. - frx of proximal 1/3 of radius & frx of ulna at the same level; - Exam: It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. 2011 Feb. 77 (1):21-6. [15] The mean postoperative increase in MEPI score was 30. anteriorangulation (usually proximal third); PDF Monteggia fracture dislocation equivalents analysis of eighteen cases Philadelphia: Lippincott Williams & Wilkins; 2012: 351-65. [QxMD MEDLINE Link]. The Monteggia lesion. Separate radiographs should be taken of the elbow. The first case is a combined type III Monteggia injury with ipsilateral Type II Salter-Harris injury of the distal end radius fracture with metaphyseal fracture of the (26/80), Level 4 Must have high index of suspicion high incidence of missed injuries (Waters, 2010), Appropriate radiographic imaging is essential to making the correct diagnosis, Be aware of plastic deformation of the ulna. Orthopedics. Ulna - Physiopedia Kopriva J, Awowale J, Whiting P, Livermore A, Siy A, Hetzel S, et al. head is not promptly reduced; Ulnar fracture with late radial head dislocation: delayed Monteggia fracture. It is imperative to look for associated injuries of the radial head and coronoid, which alter the management and lead to altered outcomes. Monteggia fracture-dislocations remain a relatively uncommon injury. - dislocation of radial head may be missed, eventhough frx of ulna is obvious (need AP, lateral and olbique X-rays of elbow) Kathmandu Univ Med J (KUMJ). Orthopaedic Specialists of North Carolina. Evans in 1949 2018 Oct. 102 (Suppl 1):93-102. A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. In his classic 1943 text, Watson-Jones stated that "no fracture presents so many problems; no injury is beset with greater difficulty; no treatment is characterized by more general failure." Bae DS. Wheeless' Textbook of Orthopaedics. Clinical effect of manual reduction of humeroradial joint in the treatment of type - fresh Monteggia fracture in children. 2. Zivanovic D, Marjanovic Z, Bojovic N, Djordjevic I, Zecevic M, Budic I. Neglected Monteggia Fractures in Children-A Retrospective Study. - non union of frx of ulnar shaft 2021 Apr-Jun. - when dx is delayed < 3 months, ORIF is indicated; Forty-eight patients who had been followed for a minimum of two years (average, 6.5 years; range, two to fourteen years) were identified. Thank you. Chin J Traumatol. Pediatric hand and upper limb surgery: a practicalguide. Removal of forearm plates. Instituzioni Chirrugiche. Findings associated with the concomitant radial head dislocation are often subtle and can be overlooked. The Monteggia fracture is relatively rare. It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. - PIN palsy is most common in type I frx and may occur in a delayed fashion if theradial [15] The average follow-up period was 5.5 years. Pronation injuries of the forearm, with special reference to theanterior Monteggia fracture.