Missed Monteggia injuries Kenneth S. David-West * , Neil I.L. Wilson, David A. Sherlock, George C. Bennet Department of Orthopaedic Surgery, The Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK Accepted 16 December 2004 Introduction In the classic Monteggia injury, there is a fracture of the ulna with dislocation of the radial head. The Monteggia variant injury comprises a dislocation or subluxation of the radial head with plastic deformation rather than a fracture of the ulna. 7 The diagnosis is aided by noting malalignment of the radial head on the capitellum on the initial lateral radiograph. 12 However, bowing of the radial shaft at the tuberosity can make drawing the radio-capitel- lar line difficult and hard to interpret. 10 Subsequent dislocation has been described as late as 3 weeks in a patient with an initially normal radiograph. 13 Neglected Monteggia injuries can lead to pain, instability and deformity. 8 We performed a retrospective study of all our Monteggia fractures to assess the outcomes for missed injuries. Injury, Int. J. Care Injured (2005) 36, 1206—1209 www.elsevier.com/locate/injury KEYWORDS Missed Monteggia variant injury; Ulnar plastic deformation Summary The classical Monteggia injury comprises a dislocation of the radial head with an associated fracture of the ulna. In the variant type, there is no ulnar fracture merely plastic deformation. We performed a retrospective study of all Monteggia injuries from 1992 to 2001. A total of 39 were reviewed, of which 8 were missed (1 classical and 7 variant). Of those, five were male and three female with a mean age of 6.3 years. The mean follow-up was 2.5 years, with a mean interval between injury and diagnosis of 33.5 weeks. Two Monteggia injuries diagnosed within 4 weeks were successfully treated by closed manipulation. The other six required ulnar osteotomy, repair of the annular ligament and stabilisation of the radial head with a transcapitellar pin. A protocol for the diagnosis of Monteggia injuries is described. Doubtful cases require an immediate review since early treatment improves the outcome. Acceptable clinical and radiological results in late diagnosed Monteggia injuries can result from ulnar osteotomy, open reduction of the radial head with repair of the annular ligament and transcapitellar pin stabilisation of the reduced radial head. # 2004 Elsevier Ltd. All rights reserved. * Corresponding author. Present address: 14 Kirkiag Avenue, Dean Park, Renfrew PA4 0YH, UK. Tel.: +44 141 5612103; mobile: 07887766283; fax: +44 141 5612103. E-mail address: kd-west@ntlworld.com (K.S. David-West). 0020–1383/$ — see front matter # 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2004.12.033