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Ortop Traumatol Rehabil 2021 Apr;23(2):79-91

Oddział Chirurgii Urazowo-Ortopedycznej, Szpital Dziecięcy im. prof. dr. med. Jana Bogdanowicza, Warszawa, Polska / Department of Trauma and Orthopaedic Surgery, Prof. Jan Bogdanowicz Children's Hospital, Warsaw, Poland.

Background: The purpose of this paper is to evaluate the usefulness of radiographic indices of humero-radial joint instability in order to predict treatment outcomes in Monteggia fractures.

Material And Methods: A retrospective analysis was conducted in a group of patients who underwent closed reduction and internal titanium elastic nail (TEN) fixation of the ulna and closed reduction of a dislocation of the radial head between 2016 and 2018. The indications for intrame-dullary fixation comprised transverse or short oblique fractures. 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

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

J Pediatr Orthop B 2021 Mar;30(2):196-202

Department of Orthopaedics Surgery, Children's Hospital of Fudan University, Minhang District, Shanghai.

Olecranon fractures are seen substantially more often in children than in adult and are potentially occult in nature. We noticed this fracture pattern in two cases of delayed Monteggia fracture. Our study purpose was to confirm whether olecranon fracture is associated with radial head subluxation or annular ligamentous displacement in children. 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

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

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 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

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

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

Unfallchirurg 2019 Sep;122(9):736-743

Klinik für Unfall‑, Hand- und orthopädische Chirurgie, Städtisches Klinikum Karlsruhe, Moltkestr. 90, 76133, Karlsruhe, Deutschland.

Transposition of the proximal radioulnar joint, so-called convergent elbow dislocation, is an extremely rare injury whereby the proximal radius crosses over the proximal ulnar and converges medially. This injury can occur in isolation or even less frequently in association with a posterior humeroulnar dislocation. Open reduction is almost always necessary. Read More

Injury 2019 Jun 27;50(6):1237-1241. Epub 2019 Apr 27.

Department of Orthopedics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, China; Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi, China. Electronic address:

Purpose: The aim of the study was to investigate the clinical outcomes of a combined anterior and posterior approach for the surgical treatment of chronic Monteggia fractures in children.

Materials And Methods: From November 2010 to January 2018, 33 patients (27 boys and 6 girls) with chronic Monteggia fracture who were treated surgically by one surgeon of our department were retrospectively analyzed. In the surgical procedure, open reduction and excision of fibrous scar were performed with the anterior Henry's approach, while ulnar osteotomy was carried out with a posterior approach. Read More

J Hand Surg Asian Pac Vol 2019 Jun;24(2):247-250

1 Department of Orthopaedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

We encountered a case of capitellum fracture with radial head dislocation in which it was challenging to diagnose whether the dislocation was coincident with the fracture or this was chronic dislocation that presented before the fracture. Chronic radial head dislocation may be congenital or could occur in patients with untreated post-traumatic dislocation, although diagnosis is particularly challenging if the radial head dislocation is unilateral. Classical capitellum fracture involves anterosuperior bone fragment dislocation. Read More

Medicine (Baltimore) 2019 Apr;98(16):e15310

Department of Orthopedics, Shengjing Hospital of China Medical University, Shenyang, China.

Rationale: The old Monteggia fracture is an uncommon lesion pattern in adult, which may lead to the potential complications such as recurrent dislocation of the radial head, heterotopic ossification of the elbow, nerve palsy, malunion of the ulna, and residual forearm deformity. However, the secondary distal radioulnar joint (DRUJ) dislocation is rarely reported in the similar lesion. Here we present a unique reoperation of old Monteggia fracture combined with secondary DRUJ disruption after the initial operation failure. Read More

Pediatr Emerg Care 2019 Apr;35(4):293-298

Assistant Professor and Director of Ultrasound (Gottlieb), Department of Emergency Medicine, Rush University Medical Center, Chicago, IL; Assistant Professor (Suleiman), Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.

Pediatric orthopedic injuries are a common reason for presentation to the emergency department. This article sequentially discusses 2 important upper extremity injuries that require prompt management in the emergency department. Radial head subluxations are discussed with a focus on current evidence for imaging, reduction techniques, and follow-up. Read More

J Pediatr Orthop B 2019 May;28(3):256-266

Department of Pediatric Orthopedics and Traumatology, Istituto Ortopedico Rizzoli, Via Pupilli, Bologna, Italy.

The treatment of a missed Monteggia (MM) fracture dislocation is still controversial. We describe our initial experience with ulnar osteotomy and progressive correction with unilateral external fixator in MM. We retrospectively evaluated 20 children undergoing ulnar osteotomy and progressive distraction angulation by unilateral external fixator to treat MM. Read More

Acta Biomed 2018 12 19;90(1-S):154-157. Epub 2018 Dec 19.

Orthopaedic and Traumatology Department, Hospital Santa Maria delle Croci, Ravenna, Italy.

Background: The annular ligament has a crucial role in the radial head stability and  it is critical to the proper functioning of the proximal  radio-capitellar joint. Its chronic injury may lead to radial head instability, elbow pain with decrease in motion and valgus deformity. Method: We present the case of a 53-year-old heavy laborer who reported a complex trauma of the right upper limb with a Floating Elbow Injury, associated to an open Monteggia fracture-dislocation. Read More

Orthop Surg 2019 Feb 4;11(1):102-108. Epub 2019 Feb 4.

Department of Pediatric Orthopaedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China.

Objective: The treatment of missed Monteggia fracture remains a challenge, despite the various surgical methods described. The purpose of this study was to explore a new surgical technique utilizing external fixator-assisted ulnar osteotomy and to assess the surgical results in a case series.

Methods: Thirteen patients with missed Monteggia fractures were treated at our institution using this new surgical technique from August 2012 to January 2016. Read More