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Orthop Surg 2021 May 4. Epub 2021 May 4.

VietDuc University Hospital, Hanoi, Vietnam.

Background: The traumatic dislocation of the radial head in children is commonly treated by closed reduction. Sometimes, however, this strategy of treatment may not be effective due to the location of soft tissues in the radio-shoulder joint. The literature presents a few cases of the irreducible radial head dislocation with ulnar plastic deformation. Read More

Medicine (Baltimore) 2021 Mar;100(10):e25129

Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology.

Abstract: A neglected Monteggia fracture is defined as the fracture of the proximal ulna associated with radial head dislocation (RHD) without undergoing any treatment for 4 weeks or more after injury. One-stage operation of ulnar corrective osteotomy and open reduction of RHD might result in many complications. Therefore, a two-stage strategy, including ulnar osteotomy (UO) with or without annular ligament reconstruction (ALR), was adopted at our institute since 2010. Read More

Eur J Trauma Emerg Surg 2021 Apr 3;47(2):283-292. Epub 2021 Mar 3.

Olgahospital Stuttgart, Stuttgart, Germany.

Purpose: Nonunion of the radial neck poses an enormous challenge for treating surgeons. It is a very rare complication of the radial neck with limited experiences. In this current major study, the authors report of their own experiences concerning this problem. Read More

Cureus 2020 Nov 19;12(11):e11564. Epub 2020 Nov 19.

Orthopaedic and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS.

Monteggia fracture is commonly treated with open anatomical reduction and fixation of the ulna fracture. The radial head will be automatically reduced once anatomical fixation of the ulna is achieved. However, it is occasionally associated with an irreducible radial head dislocation requiring an open reduction and reconstruction of the torn annular ligament. Read More

Clin Shoulder Elb 2020 Mar 21;23(1):27-30. Epub 2020 Feb 21.

Department of Shoulder and Elbow, Fundación Santa Fé de Bogotá, Bogotá, Colombia.

Osborne-Cotterill lesion is an osteochondral fracture located in the posterolateral margin of the humeral capitellum, which may be associated with a defect of the radial head after an elbow dislocation. This lesion causes instability by affecting the lateral ulnar collateral ligament over its capitellar insertion, which is associated with a residual capsular laxity, thereby leading to poor coverage of the radial head, and hence resulting in frequent dislocations. We present a 54-year-old patient, a physician who underwent trauma of the left elbow after falling from a bike and suffered a posterior dislocation fracture of the elbow. Read More

Bone Joint J 2020 Dec;102-B(12):1620-1628

Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany.

Aims: To evaluate the outcomes of terrible triad injuries (TTIs) in mid-term follow-up and determine whether surgical treatment of the radial head influences clinical and radiological outcomes.

Methods: Follow-up assessment of 88 patients with TTI (48 women, 40 men; mean age 57 years (18 to 82)) was performed after a mean of 4.5 years (2. Read More

Hand Clin 2020 11 2;36(4):429-441. Epub 2020 Sep 2.

Department of Plastic & Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address:

This article reviews the anatomy and mechanics of pronation and supination (axial rotation) of the forearm through the distal radioulnar joint (DRUJ), and the proximal radioulnar joint (PRUJ). Injuries to the bones and/or ligaments of the forearm, wrist, or elbow can result in instability, pain, and limited rotation. Acute dislocations of the DRUJ commonly occur along with a fracture to the distal radius, radial metadiaphysis, or radial head. Read More

BMC Musculoskelet Disord 2020 Oct 7;21(1):659. Epub 2020 Oct 7.

Orthopedics and Traumatology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena Via del Pozzo 71, 41124, Modena, Italy.

Background: Radial head dislocation with no associated lesions, is a relatively uncommon injury in children. In this case report, it is reported a case of anteromedial locked radial head dislocation in children, and we discuss its clinical presentation and pathogenetic mechanism of injury.

Case Presentation: An 8-year-old girl fell off on her right forearm with her right elbow extended in hyperpronation. Read More

J Int Med Res 2020 Aug;48(8):300060520949079

Department of Orthopedic Surgery, Yantaishan Hospital, Yantai City, Shandong Province, China.

Objective: Missed Monteggia fractures are commonly observed among children. Both the interval from the injury to surgery and the patient's age at operation are thought to be correlated directly with the success of the surgery and prognosis. The aim of the present work was to report one interesting adult case of a missed Monteggia fracture with an intact annular ligament 9 years after injury and the outcomes at a 7-year follow-up. Read More

J Pediatr Orthop B 2021 Mar;30(2):190-195

Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan.

Treatment of a Monteggia fracture-dislocation primarily includes anatomical reduction and fixation of the ulna. However, in rare cases, reduction of the radial head remains impossible even after performing this standard procedure. We have encountered patients with Monteggia fracture-dislocation whose radial head could be reduced by 'overcorrecting' the ulna. Read More

Clin Orthop Relat Res 2021 Jan;479(1):119-125

P. J. Ostergaard, M. A. Tarabochia, M. J. Hall, G. Dyer, B. E. Earp, P. Blazar, D. Zhang, Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Background: Terrible triad injuries of the elbow, consisting of posterior ulnohumeral joint dislocation with associated fractures of the radial head and coronoid process, are challenging injuries due to the difficulty in restoring stability to the joint surgically while also attempting to allow early ROM to prevent stiffness. Furthermore, complications are both debilitating and relatively common, frequently requiring reoperation.

Questions/purposes: (1) What patient-, injury-, or surgery-related factors are associated with reoperation after surgical treatment of terrible triad injuries of the elbow? (2) What are the most common causes of reoperation after these injuries?

Methods: Between January 2000 and June 2017, we identified 114 patients who had surgery for terrible triad injuries at two tertiary-care referral centers. Read More

J Am Acad Orthop Surg 2020 Oct;28(19):e839-e848

Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY.

Monteggia fractures involve proximal ulna fracture associated with a radiocapitellar joint dislocation. The Bado classification is primarily based on the direction of the radial head dislocation. The Jupiter subtype classification of Bado II fractures further characterizes the severity of proximal ulna comminution and the involvement of the coronoid fragment. Read More

Clin Sports Med 2020 Jul;39(3):623-636

The Steadman Clinic, Steadman Philippon Research Institute, 181 West Meadow Drive, Suite 400, Vail, CO 81657, USA. Electronic address:

The elbow joint consists of the humeroulnar, humeroradial, and proximal radioulnar joints. Elbow stability is maintained by a combination of static and dynamic constraints. Elbow fractures are challenging to treat because the articular surfaces must be restored perfectly and associated soft tissue injuries must be recognized and appropriately managed. Read More

BMC Musculoskelet Disord 2020 May 6;21(1):282. Epub 2020 May 6.

Department of Orthopaedics, Children's Hospital, Zhejiang University School of Medicine, 14th Floor, Inpatient Building, No. 3333 Binsheng Road, Hangzhou, Zhejiang, People's Republic of China.

Background: Monteggia equivalent lesion represents a series of combined elbow and forearm injuries that resemble typical Monteggia fracture either in presentation or mechanism. The term has gradually evolved since its introduction, as sporadic case reports continued to complement it. The aim of this study was to present a furthermore type of that lesion which no previous study had reported and arouse pediatric orthopedists' additional awareness of it. Read More

J Orthop 2020 Sep-Oct;21:207-212. Epub 2020 Mar 28.

University of Health Sciences, Kartal Dr. Lütfi Kırdar Research and Training Hospital, Department of Orthopaedics and Traumatology, Denizer St. Cevizli 34806, Kartal, İstanbul, Turkey.

Objectives: Management of missed Monteggia lesions presents a challenging clinical scenario for pediatric orthopaedic surgeons as the patient may be exposed to possible morbidities and increased complications. There are several evidenced surgical strategies described. We aimed to present 18 patients diagnosed within 4 months of injury who were treated using 4 of the identified many surgical strategies. Read More

J Bone Joint Surg Am 2020 Jun;102(12):1066-1074

Department of Pediatric Orthopaedics, Children's Hospital of Fudan University, Shanghai, China.

Background: Ulnar lengthening is a consensus treatment for hereditary multiple exostoses with radial head dislocation in pediatric patients; however, the optimal amount of ulnar lengthening remains unclear. It is necessary to look for a parameter to decide the amount of ulnar lengthening that will avoid recurrence and complications. The purpose of the present study was to confirm that proportional ulnar length (ulnar length/radial length) can be used as a scale for ulnar lengthening in pediatric patients. Read More

Eur J Orthop Surg Traumatol 2020 Aug 26;30(6):1017-1024. Epub 2020 Mar 26.

Department of Orthopedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.

Purposes: To evaluate the outcome of different types of ulna osteotomy in missed Monteggia fracture with a particular interest in anatomical correction and overcorrection techniques. The outcome between the two groups were compared on aspects of (1) clinical outcome (2) radiologic outcome.

Methods: Twenty-one patients with type 1 missed Monteggia fracture who underwent surgery between January 2005-2018 were retrospectively reviewed. Read More

JBJS Case Connect 2020 Jan-Mar;10(1):e0445

Pediatric Orthopaedic Department, Geneva University Hospitals, Geneva, Switzerland.

Case: A 14-year-old girl sustained a posterior elbow dislocation and presented with a proximal radioulnar translocation (PRUT) and a displaced fracture of the radial head. Reduction of the elbow dislocation and the proximal radioulnar translocation were achieved by external manipulation in the operating room. The radial head was not amenable to closed reduction and remained entrapped in the anteromedial compartment of the elbow. Read More

Instr Course Lect 2019 ;68:407-414

Since pediatric Monteggia fracture-dislocations were first described in 1814, they have been a complicated injury for orthopaedic surgeons to manage. These injuries typically consist of a fracture of the ulna with dislocation of the radial head. Unlike most pediatric injuries, Monteggia fracture-dislocations remodel very poorly, and the relationship between the radial head and the capitellum does not improve with time. Read More

Arthroscopy 2020 02;36(2):441

Ghent University Hospital.

Arthroscopic reduction and fixation techniques in elbow surgery are evolving, and more and more literature is describing good outcomes of new arthroscopic fixation methods for coronoid fractures, lateral collateral ligament tears, radial head fractures, or capsular avulsions. The possible next step could be to use all these different techniques in cases in which all the described lesions can be seen. However, the question is if this approach is too aggressive. Read More

J Pediatr Orthop 2020 Apr;40(4):e293-e299

Department of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Background: Radial head dislocation with ulnar bowing (Monteggia type I equivalent injury) is a frequently missed injury. If not recognized acutely, these missed injuries can lead to serious long-term complications. The purpose of this study was to evaluate the rate of missed diagnosis and to report on the characteristics and early management of this specific injury pattern. Read More

Rev Bras Ortop (Sao Paulo) 2019 Dec 13;54(6):746-750. Epub 2019 Dec 13.

Departmento de Ortopedia, Government Medical College Hospital, Chandigarh, Índia.

Isolated anterior dislocation of the radial head is rarely reported. To date, only five cases have been reported in the world literature. In all of these cases, the patients presented with restricted supination-pronation movements of the forearm with maintained elbow flexion-extension. Read More

Arthroscopy 2020 02 19;36(2):431-440. Epub 2019 Dec 19.

Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Republic of Korea. Electronic address:

Purpose: To evaluate the results of all-arthroscopic treatment of the terrible triad of the elbow, a combination of elbow dislocation, radial head dislocation, and coronoid process fracture, and its complications.

Methods: We performed a retrospective review of consecutive patients with terrible triad who underwent all-arthroscopic treatment between January 2011 and December 2016. All-arthroscopic treatment was performed in the unstable elbows after manual reduction. Read More

Chin J Traumatol 2019 Dec 31;22(6):340-344. Epub 2019 Oct 31.

Department of Orthopedic Center, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing 400014, China. Electronic address:

Purpose: To investigate the characteristics of the onset and treatment of radial head subluxation (RHS) in pediatric clinics and emergency departments.

Methods: A retrospective study was performed on 11, 404 RHS cases in 9827 children who visited pediatric clinics and emergency departments from January 2015 to December 2018. The patients who with history of trauma and fracture of the affected limb were excluded. Read More

J Orthop Surg Res 2019 Nov 8;14(1):347. Epub 2019 Nov 8.

Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, 1055 Sanxiang Road, Suzhou, 215006, China.

Background: The objective of the study was to depict the pathoanatomy of traumatic valgus instability of the elbow and to report clinical outcomes of primary operation.

Methods: Thirty-one patients presented with traumatic valgus instability of the elbow without dislocation. Thirty-one patients underwent surgical intervention of radial head fractures (28 open reduction and internal fixation and 3 radial head resection) and anatomical repair of the anterior bundle of medial collateral ligament (AMCL) with suture anchors. Read More

Adv Emerg Nurs J 2019 Oct/Dec;41(4):330-335

Emergency Nurse Practitioner Program, Vanderbilt University School of Nursing, Nashville, Tennessee.

Nursemaid's elbow, also known as radial head subluxation, is a common childhood orthopedic injury that can easily be diagnosed and reduced by the advanced practice nurse. It is most common in children 1-4 years of age and typically occurs as the result of a pulling mechanism on an outstretched arm. This leads to subluxation of the radial head at the annular ligament. Read More

J Shoulder Elbow Surg 2020 Jan 11;29(1):132-138. Epub 2019 Sep 11.

Orthopaedic and Trauma Unit, University of Modena and Reggio Emilia, Modena, Italy.

Background: The aim of this study was to determine the lateral ulnar collateral ligament (LUCL) injury associated with isolated radial head fracture (RHF) and the relationship of the ligament injury with the displacement of the fragment-loss of contact-in unstable displaced partial articular RHF in individuals without any history of ulnohumeral dislocation.

Methods: We retrospectively identified 131 consecutive patients who underwent open reduction and internal fixation of isolated closed Mason type II RHF performed at our institution. We identified 3 subsets by the pattern of RHF and the position of the unstable fragment (anterior or posterior) relative to the capitulum humeri: displaced stable (group I), displaced anterior unstable (group II), and displaced posterior unstable (group III). Read More

Vet Surg 2019 Oct 26;48(7):1271-1277. Epub 2019 Jul 26.

Division for Farm Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland.

Objective: To describe the clinical signs, conservative treatment, and short- and long-term outcomes of lateral radioulnar subluxation in cattle.

Animals: Three cattle with lateral radioulnar subluxation.

Study Design: Case series. Read More

J Shoulder Elbow Surg 2019 Aug;28(8):1468-1475

Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.

Background: Radial head dislocation may occur during trauma or in association with congenital diseases, or it may be developmental or idiopathic. Reports of idiopathic dislocation of the radial head have been scarce. The symptoms, radiographic findings, and management of idiopathic dislocation of the radial head have not been well described in the literature. Read More

J Orthop Trauma 2019 Aug;33 Suppl 1:S13-S14

NYU Langone Medical Center, NYU Langone Orthopedic Hospital, New York, NY.

Introduction: Monteggia fractures are rare, although complex elbow injuries. Bado II Monteggia fractures are characterized by posterior dislocation of the radial head and concurrent fracture of the proximal or middle third of the ulna. This video demonstrates the open reduction and internal fixation of a complex Bado II Monteggia fracture dislocation. Read More