This 2016 narrative review by Bae covers the full spectrum of pediatric Monteggia fracture-dislocations. It addresses acute diagnosis, a fracture-pattern-based surgical algorithm, and reconstructive principles for chronic missed cases. The paper synthesizes classification systems and multicenter outcome data to guide management decisions.
Every pediatric forearm radiograph requires a deliberate check of the radiocapitellar line: the longitudinal axis of the radius must bisect the capitellar ossification center on all views. If it does not, you have a Monteggia injury until proven otherwise — and up to one-third are missed at first contact.
When you confirm an acute Monteggia, the ulnar fracture pattern drives your treatment decision, not the direction of radial head dislocation. Incomplete fractures (plastic deformation, greenstick) get closed reduction and casting. Complete fractures get surgical fixation, with the specific construct chosen by fracture length-stability.
For chronic presentations with pain or motion loss, reconstruction is indicated as long as the radial head retains its concave morphology. The reconstructive sequence is ulnar osteotomy first, then radiocapitellar reduction, then annular ligament repair or reconstruction using triceps fascia, forearm fascia, or free tendon graft.
The radial nerve runs in the brachialis-brachioradialis interval and must be identified and protected throughout chronic reconstruction via a posterolateral approach.
This 2016 narrative review by Bae covers the full spectrum of pediatric Monteggia fracture-dislocations. It addresses acute diagnosis, a fracture-pattern-based surgical algorithm, and reconstructive principles for chronic missed cases. The paper synthesizes classification systems and multicenter outcome data to guide management decisions.
Every pediatric forearm radiograph requires a deliberate check of the radiocapitellar line: the longitudinal axis of the radius must bisect the capitellar ossification center on all views. If it does not, you have a Monteggia injury until proven otherwise — and up to one-third are missed at first contact.
When you confirm an acute Monteggia, the ulnar fracture pattern drives your treatment decision, not the direction of radial head dislocation. Incomplete fractures (plastic deformation, greenstick) get closed reduction and casting. Complete fractures get surgical fixation, with the specific construct chosen by fracture length-stability.
For chronic presentations with pain or motion loss, reconstruction is indicated as long as the radial head retains its concave morphology. The reconstructive sequence is ulnar osteotomy first, then radiocapitellar reduction, then annular ligament repair or reconstruction using triceps fascia, forearm fascia, or free tendon graft.
The radial nerve runs in the brachialis-brachioradialis interval and must be identified and protected throughout chronic reconstruction via a posterolateral approach.