Ulnar has apex anterior & the radial head is anterior (75%) – supinate arm
II
Posterior ulnar apex & posterior radial head- pronate arm
III
Lateral ulnar angulation & dislocation of the radial head – arm in neutral
IV
Anterior dislocation of the head & fracture of the shaft of the radius
Baldo Classification of Monteggia Fracture Dislocations
Equivalents include physeal separations & plastic deformation of the ulna
Nerve palsy in 10% – 67%
Treatment
Type
Treatment
Type 1
>90° of elbow flexion & supination
Type 2
elbow extension & pronation
Type 3
20 degree elbow flexion & neutral rotation
Type 4
generally open reduction of forearm
Treatment of Monteggia Fractures
Closed reduction & anatomic reduction of the ulna is required otherwise the radial head will not stay reduced
Open Technique
If inadequate or unstable reduction
Address the ulna first with a plate or IM technique
Then reduce the radius, if the radius not reducing
Open the radiocapitellar joint through the interval ECU & anconeus
If still unreduced pin the joint
The Missed Monteggia
Progressive valgus deformity
Unstable elbow in valgus
Good results by reconstructing up to 4 years after the injury
Arthrogram will show if it is congenital versus post-traumatic – based on hole in capsule if traumatic
Make sure that this is not a congenital dislocation
Evaluate the joint surface intraoperatively
Open reduction of the radial head & release of the interposed annular ligament, ulnar osteotomy to address the bowing & ↑ length
Internal fixation of the ulnar osteotomy
Repair of the annular ligament – Bell Toss if unstable – use a long slip of the triceps fascia & it is used to fashion a loop around the radial neck to hold the reduction
If still unstable pin the radius to the capitellum
Galeazzi Fracture
< 12 – closed reduction of the radius & immobilisation in supination
if in doubt order a CT scan
> 12 ORIF of the radius & possible closed reduction of the ulna, if stable immobilise in cast with supination, if unstable or not reducible open the drug dorsally & clean out the crap & then pin it with repair of the local TFCC
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.
