Monteggia Fractures: Pearls and Pitfalls

The entity of Monteggia fractures describes a spectrum of fracture-dislocations in which the radiocapitellar joint becomes disrupted in association with an ulnar shaft fracture. While these injuries are relatively uncommon in the pediatric population, they pose both a diagnostic and therapeutic challenge, as the constellation of these injuries can be subtle and difficult to identify. As such, they are often missed or neglected in the setting of a minimally displaced ulnar shaft fracture in which the radiocapitellar dislocation goes unrecognized. There is a wide spectrum of treatment strategies for pediatric Monteggia fractures, from closed reduction and immobilization in the acute setting to extensile open reconstructive techniques for chronic cases. Outcomes can be variable depending on the time of treatment and age of the patient. The most important principle for management of these injuries is early recognition and close follow-up to prevent poor outcomes.