Monteggia fractures in pediatric and adult populations

A Monteggia fracture is a fracture of the proximal ulna coupled with a radial head dislocation. These fractures are an uncommon class of forearm fractures. Numerous classification systems have been developed to characterize these fractures, with the Bado classification being the most common. Elbow radiographs are the primary diagnostic modality, demonstrating dislocation when a line drawn extending through the radial head from the radial shaft does not penetrate the capitellum in all views. Notable differences exist in the prevalence, treatment, and outcomes of Monteggia fractures for pediatric and adult patient populations, with adolescents often achieving a better prognosis. Nonoperative management with closed reduction and cast immobilization often prevails in pediatric patients, dictated by the pattern of the ulnar fracture more so than the direction of the radial head dislocation. However, in adults, operative intervention is frequently indicated because angulation and shortening of the ulna often occur after closed reduction. Although the orthopedic community's understanding of these fractures has evolved, the fractures themselves remain a challenging clinical phenomenon. This article reviews the relevant anatomy and pathogenesis, classification, clinical presentation, diagnostic studies, management, outcomes, and complications of Monteggia fractures in children and adults.