Usually, anatomical reduction of the ulna allows for a closed reduction of the radial head. Types I, III, IV are cast at 110° of flexion, whereas type II is cast at 70° of flexion 4,6. In the pediatric population, isolated closed reduction may be possible. That an apparently isolated ulnar plastic/ greenstick fracture may actually represent a Monteggia-equivalent lesion with spontaneous radial head reductionĪll four types of Monteggia fracture-dislocations (see Bado classification) are typically treated with open reduction and internal fixation of the ulna and radius. That up to 24% of cases are associated with a distal radial fracture The age-dependent normal appearance of the elbow centers of ossification, which could mimic a fracture to the inexperienced eye Regarding pediatric patients, one should take into account: Provided that films of adequate quality are obtained, the ulnar fracture is usually obvious and the radial head dislocation should be readily identifiable. When a forearm fracture is identified, dedicated imaging of both the elbow and the wrist is important and good quality AP and lateral views are essential.
Monteggia fractures occur mostly in children (peak incidence at ages 4-10 years) and rarely in adults.