Monteggia fracture-dislocations in children. [11, 12] Of the Monteggia fractures, Bado type I has been reported to be the most common (59%), followed by type III (26%), type II (5%), and type IV (1%). In 1991, Anderson and Meyer used the following criteria to evaluate forearm fractures and their prognosis Wheeless' Textbook of Orthopaedics. - type II lesions with posterior dislocations should be maintained in about 70 deg. Some injuries associated with radiocapitellar dislocation (such as the transolecranon fracture-dislocation of the elbow) are mislabeled as Monteggia lesions, when in fact the PRUJ remains intact. It is the character of the ulnar fracture, rather than the direction of radial head dislocation, that is useful in determining the optimal treatment of Monteggia fractures in both children and adults. Ramski, D., Hennrikus, W., Bae, D., et. J Hand Surg Am. (0/1), Level 3 [QxMD MEDLINE Link]. Evans in 1949 The distal ulna and radius also articulate at the DRUJ. Pronation injuries of the forearm, with special reference to theanterior Monteggia fracture. Anterior elbow dislocations occur most often as a fracture-dislocation in which the distal humerus is driven through the olecranon, thereby causing a complex, comminuted fracture of the proximal ulna. Share cases and questions with Physicians on Medscape consult. Once the cast is hardened, mark it, then split using an oscillating saw, a hand saw, or a sharp plaster knife (1). Ruchelsman DE, Pasqualetto M, Price AE, Grossman JA. Monteggia lesions in children and adults: an analysis of etiology and long-term results of treatment, Removal of forearm plates. J Bone Joint Surg Br. For patient education resources, see theBreaks, Fractures, and Dislocations Center, as well asBroken Arm,Broken Elbow, andElbow Dislocation. Curr Opin Pediatr. 2018 Feb. 104 (1S):S113-S120. [Full Text]. - immobilize forearm in neutral rotation w/ slight supination, w/ cast carefully molded over lateral side of ulna at level of fracture; Monteggia fractures in adults: long-term results and prognostic factors. Since Monteggia first described the fracture bearing his name in 1814, the association of radial head dislocation with ipsilateral ulnar fracture has been well described. The results of the present series are much better than those reported in most earlier studies, suggesting that stable anatomical fixation of the ulnar fracture (including associated fracture fragments of the coronoid process) with a plate and screws inserted with use of current techniques of fixation leads to a satisfactory result in most adults who have a Monteggia fracture. Widen the split with a cast spreader. Musculoskelet Surg. Murali Poduval, MBBS, MS, DNB is a member of the following medical societies: Association of Medical Consultants of Mumbai, Bombay Orthopedic Society, Indian Orthopedic Association, Indian Society of Hip and Knee SurgeonsDisclosure: Nothing to disclose. Rockwood CA, Green DP, Bucholz R, eds. If you log out, you will be required to enter your username and password the next time you visit. Bado JL. The radial head dislocation may not be apparent and will possibly be missed if the elbow is not included in the radiograph. 110 West Rd., Suite 227 - angulated ulnar shaft is reduced by firm manual pressure; - Type II (flexion type) - 15% On examination, the affected arm is swollen and tender around his elbow. More than 150 years later, in 1967, Bado coined the term Monteggia lesion and classified the injury into the following four types If not diagnosed at an early stage, these lesions can gradually lead to forearm deformities and dysfunction, finally resulting in neglected Monteggia fracture. LIVIN' ON THE MD EDGE: Drive, Chip, and Putt Your Way to Osteoarthritis Relief, Osteoporosis and Osteopenia: Latest Treatment Recommendations, Osteoporosis: A Bare-Bones Guide to Diagnosis and Treatment. - non union of frx of ulnar shaft In some cases, a direct blow to the forearm can produce similar injuries. This is the most common type of Monteggia fracture. (1/1), Level 4 Prompt recognition of this injury is imperative. - attempt to palpate radial head (ant, post, or lateral); - in child, a dislocated radial head should never be resected, since it will cause cubitus valgus, prominence of distal end of ulna, What is the most likely finding? Take great care to avoid injury to the underlying skin. Cast treatment with the elbow extended. J Bone Joint Surg Br. (20/80). Monteggia lesions in children and adults: an analysis of etiology and long-term results of treatment. - apex of angular deformity of ulna usually indicates direction of radial head dislocation; - Reduction: [6] Injuries to the anterior interosseous branch of the median nerve and the ulnar nerve also have been reported. Six of the eight patients who had an unsatisfactory (fair or poor) result had had a Bado type-II fracture with a concomitant fracture of the radial head. The character of the ulnar fracture is useful in determining optimal treatment. The Monteggia lesion is most precisely characterized as a forearm fracture in association with dislocation of the PRUJ. The ulna fracture is usually noted, commonly in the proximal third of the ulna. Monteggia fracture-dislocations remain a relatively uncommon injury. This fracture refers to an intraarticular fracture that separates the palmar ulnar aspect of the first metacarpal base from the remaining first metacarpal. (0/7), Level 2 Anderson LE, Meyer FN. : A retrospective study, Mortons Neuroma: Interdigital Perineural Fibrosis, Orthopaedic Specialists of North Carolina. Telephone: 410.494.4994. - Discussion: [15] The mean postoperative increase in MEPI score was 30. Richard L Ursone, MD Orthopedic Surgeon, Department of Orthopedics and Rehabilitation, Brooke Army Medical Center Waters PM, Bae DS, eds. Melvin P. Rosenwasser, MD (CSOT #21, 2016), Frontiers in Upper Extremity Surgery - 2016, Monteggia - Alfred W. Hess, MD (Frontiers #16, 2016), Monteggia Fracture Dislocation - Everything You Need To Know - Dr. Nabil Ebraheim, Undecided Surgical management is indicated for radial heads that are not stable following closed reduction. - frx of proximal ulnar diaphysis with posterior angulation; Watson-Jones R. Fracture and Joint injuries. J Pediatr Orthop. History Mystery: Did Subdural Hematoma Kill Thomas Aquinas? Which direction is the radial head most likely dislocated? Modified technique for correction of isolated radial head dislocation without apparent ulnar bowing: a retrospective case study. These unsatisfactory results were related to a malunited fracture of the coronoid process in two patients, a proximal radioulnar synostosis in one, a malunited fracture of the coronoid process and a proximal radioulnar synostosis in one, a malunion of the ulna in one, and painfully restricted rotation of the forearm after operative fixation of a comminuted fracture of the radial head in one. 2013. The first case is a combined type III Monteggia injury with ipsilateral Type II Salter-Harris injury of the distal end radius fracture with metaphyseal fracture of the Injury. - Mechanism: - proposed mechanisms include direct blow & hyperpronation injuries as well- as the hyperextension theory; The Monteggia lesion. In his classic 1943 text, Watson-Jones stated that "no fracture presents so many problems; no injury is beset with greater difficulty; no treatment is characterized by more general failure." [1], The first challenge is correctly assessing the extent and nature of the injury. Separate radiographs should be taken of the elbow. [QxMD MEDLINE Link]. 39 (4):451-5. Problems with the elbow related to fractures of the coronoid process and the radial head, which are common with Bado type-II Monteggia fractures, remain the most challenging elements in the treatment of these injuries. (0/1), Level 3 Monteggia described a fracture of the proximal third of the ulna with anterior dislocation of the radial head from both the proximal radioulnar and radiocapitellar joints. and radial deviation of head; - Complications: [QxMD MEDLINE Link]. Forty-eight patients who had been followed for a minimum of two years (average, 6.5 years; range, two to fourteen years) were identified. The eponym Monteggia fracture is most precisely used to refer to a dislocation of the proximal radioulnar joint (PRUJ) in association with a forearm fracture, most commonly a fracture of the ulna. - achieved w/ forarm in full supination, & longitudinal traction; Pathology of the annular ligament in paediatric Monteggia fractures. After undergoing closed reduction, the radiocapitellar joint is noted to remain non-concentric. [QxMD MEDLINE Link]. The Monteggia fracture is relatively rare. Is Bone Mineral Density Testing Underused in Prostate Cancer Care? JAMA 1940;115:1699-1705. [QxMD MEDLINE Link]. Orthopaedic Specialists of North Carolina. 2023 Lineage Medical, Inc. All rights reserved. Clin Orthop Relat Res. Ulnar fracture with late radial head dislocation: delayed Monteggia fracture. This is a report of two rare variants of Monteggia fracture-dislocation. (1/1), Level 4 Monteggia fracture - fracture of the proximal 1/3 of the ulnar shaft accompanied by the dislocation of the radial head. The close proximity of these nerves may lead to injuries when a Monteggia fracture occurs. The end result is a disrupted interosseous membrane proximal to the fracture, a dislocated PRUJ, and a dislocated radiocapitellar joint. : A retrospective study. [2]. Int J Clin Exp Med. J Hand Surg Am. Li H, Cai QX, Shen PQ, Chen T, Zhang ZM, Zhao L. Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children. Monteggia fractures account for fewer than 5% of forearm fractures, with published literature supporting figures in the range of 1-2%. Zivanovic D, Marjanovic Z, Bojovic N, Djordjevic I, Zecevic M, Budic I. Neglected Monteggia Fractures in Children-A Retrospective Study. You are being redirected to This principle also applies to aGaleazzi fracture, which is a fracture of the distal radius with concomitant dislocation of the distal radioulnar joint (DRUJ). Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. Chin J Traumatol. 1998 Dec;80(12):1733-44. Reckling FW. - note: that patients whose operative treatment is delayed may be found to have a progressive PIN palsy from 36 (2):65-73. A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. Are you sure you want to trigger topic in your Anconeus AI algorithm? Kopriva J, Awowale J, Whiting P, Livermore A, Siy A, Hetzel S, et al. Radiographically, there were 15 good results, seven fair results, and zero poor results. Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. J Am. Monteggia fractures and their variants are often misdiagnosed, however, because of the numerous atypical presentations of this injury in children. (6/78), Undecided The fracture of the radial head was treated with either complete or partial excision of the fragments in twelve patients (with replacement with a silicone prosthesis in two), open reduction and internal fixation in ten patients, and no intervention in four patients. J Bone Joint Surg Am. J Am Acad Orthop Surg. These injuries are relatively uncommon, accounting for fewer than 5% of all forearm fractures. With careful definition, specific subsets of patients may benefit from consideration as a separate type of Monteggia injury. [7] Interestingly, he described this injury pattern in the pre-Roentgen era solely on the basis of the history of injury and the physical examination findings. Milan: Maspero; 1814. vol 5: Bado JL. The Monteggia fracture with posterior dislocation of the radial head. The keys to successful diagnosis of a Monteggia fracture are clinical suspicion and radiographs of the entire forearm and elbow. - proposed mechanisms include direct blow & hyperpronation injuries as well-as the A Monteggia fracture is defined as a proximal 1/3 ulna fracture with an associated radial head dislocation. (OBQ09.264) Since Monteggia first described the fracture bearing his name in 1814, the association of radial head dislocation with ipsilateral ulnar fracture has been well described. Forearm fractures in children. Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). al. An Alternative to the Traditional Radiocapitellar Line for Pediatric Forearm Radiograph Assessment in Monteggia Fracture. You can rate this topic again in 12 months. Copyright 2023 Lineage Medical, Inc. All rights reserved. for: Medscape. Clin Orthop Relat Res. 2021 Nov. 46 (11):1006-1015. - then elbow is gently flexed to > 90 deg to relax biceps; Are you sure you want to trigger topic in your Anconeus AI algorithm? The Monteggia fracture with posterior dislocation of the radial head. When the ulna is fractured, energy is transmitted along the interosseous membrane, displacing the proximal radius. Orthopedics. Kathmandu Univ Med J (KUMJ). [7] 2009 Jun. 2014 Jun. Steven I Rabin, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Fracture Association, American Orthopaedic Association, AO Foundation, Chicago Metropolitan Trauma Society, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society, Mid-America Orthopaedic Association, Orthopaedic Trauma AssociationDisclosure: Nothing to disclose. Fractures of the shafts of the radius and ulna. Monteggia Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports (0/1), Level 1 Fractures in Adults. Richard L Ursone, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Society of Military Orthopaedic SurgeonsDisclosure: Nothing to disclose. Are you sure you want to trigger topic in your Anconeus AI algorithm? Vol 1: Nakamura K, Hirachi K, Uchiyama S, Takahara M, Minami A, Imaeda T, et al. ORTHOBULLETS; Events. Diagnosis is made with forearm and elbow radiographs to check for congruency of the radiocapitellar joint in the setting of an ulna fracture. In addition, there are substantial differences between Monteggia injuries in children and adults. Type in at least one full word to see suggestions list, Scary Elbows: The Proximal Monteggia with David Stanley | OTS, Cleveland Combined Hand Fellowship Lecture Series 2020-2021, Monteggia Injury: Case of the Week - Joanne Wang, MD. - posterior or posterolateral dislocation of radial head (or frx); A Monteggia fracture involves a fracture of the ulna with disruption of the proximal radio-ulnar joint (PRUJ) and radiocapitellar dislocation (Bado, 1967). Breaks, Fractures, and Dislocations Center, Association of Medical Consultants of Mumbai, Illinois Association of Orthopaedic Surgeons, Limb Lengthening and Reconstruction Society. - spontaneous recovery is usual & exploration is not indicated; Please confirm that you would like to log out of Medscape. Are you sure you want to trigger topic in your Anconeus AI algorithm? - paralysis of deep branch of radial nerve is most common; [QxMD MEDLINE Link]. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Proximal radius dislocations in skeletally immature teenagers and children occur in the setting of a spectrum of ulnar injuries that often do not follow classic adult patterns. Adult Monteggia and Olecranon Fracture Dislocations of the Elbow. 4 (2):167-72. [4] The radial head articulates with the humeral capitellum and the radial notch of the proximal ulna. What are floating elbow injuries and how are they treated? different treatment protocol for children, may be part of complex injury pattern including, Fracture of the proximal or middle third of the ulna with, Fracture of the ulnar metaphysis (distal to coronoid process) with, Fracture of the proximal or middle third of the, Jupiter Classification of Type II Monteggia Fracture-Dislocations, Fracture extending to distal half of ulna, may or may not be obvious dislocation at radiocapitellar joint, may be loss of ROM at elbow due to dislocation, radial deviation of hand with wrist extension, AP and Lateral of elbow, wrist, and forearm, helpful in fractures involving coronoid, olecranon, and radial head, must ensure stabilty and anatomic alignment of ulna fracture, acute fractures which are open or unstable (long oblique), most Monteggia fractures in adults are treated surgically, ORIF of ulna shaft fracture, open reduction of radial head, failure to reduce radial head with ORIF of ulnar shaft only, Monteggia "variants" with associated radial head fracture, lateral decubitus position with arm over padded support, midline posterior incision placed lateral to tip of olecranon, develop interval between flexor carpi ulnaris and anconeus along ulnar border proximally, and interval between FCU and ECU distally, with proper alignment of ulna radial head usually reduces and open reduction of radial head is rarely needed, failure to align ulna will lead to chronic dislocation of radial head, treatment based on involved components (radial head, coronoid, LCL), if no improvement obtain nerve conduction studies, usually caused by failure to obtain anatomic alignment of ulna, If diagnosis is delayed greater than 2-3 weeks complication rates increase significantly, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. anterior dislocation of radial head; It is imperative to look for associated injuries of the radial head and coronoid, which alter the management and lead to altered outcomes. Towson, MD 21204 The records concerning ten consecutive years of experience with Monteggia fractures in adult patients at a level-one trauma center were retrospectively reviewed. Treatment can be isolated closed reduction in the pediatric population (if radiocapitellar joint remains stable). [QxMD MEDLINE Link]. - Monteggia Fractures in Children. 28 (19):e839-e848. [QxMD MEDLINE Link]. 1949 Nov. 31B (4):578-88, illust. The other two unsatisfactory results were in a patient who had had a Bado type-I fracture and in one who had had a Bado type-IV fracture. Hand Clin. Monteggia fracture-dislocation is rare in children 2,3,4. - radiohumeral ankylosis - lateral or anterolateral dislocation of the radial head; [QxMD MEDLINE Link]. Undecided A 12-year-old male sustains an ulnar fracture with an associated posterior-lateral radial head dislocation. 2012 Jun. - realize that even w/ successful closed reduction of the ulna (and accompanying reduction of the radial head) that subsequently Fractures in children. Rang, M., Pring, M. E., & Wenger, D. R. (2005). The median and ulnar nerves enter the antecubital fossa just distal to the elbow. J Pediatr Orthop. [QxMD MEDLINE Link]. 2021 Apr-Jun. different treatment protocol for children, may be part of complex injury pattern including, Fracture of the proximal or middle third of the ulna with, Fracture of the ulnar metaphysis (distal to coronoid process) with, Fracture of the proximal or middle third of the, Jupiter Classification of Type II Monteggia Fracture-Dislocations, Fracture extending to distal half of ulna, may or may not be obvious dislocation at radiocapitellar joint, may be loss of ROM at elbow due to dislocation, radial deviation of hand with wrist extension, AP and Lateral of elbow, wrist, and forearm, helpful in fractures involving coronoid, olecranon, and radial head, must ensure stabilty and anatomic alignment of ulna fracture, acute fractures which are open or unstable (long oblique), most Monteggia fractures in adults are treated surgically, ORIF of ulna shaft fracture, open reduction of radial head, failure to reduce radial head with ORIF of ulnar shaft only, Monteggia "variants" with associated radial head fracture, lateral decubitus position with arm over padded support, midline posterior incision placed lateral to tip of olecranon, develop interval between flexor carpi ulnaris and anconeus along ulnar border proximally, and interval between FCU and ECU distally, with proper alignment of ulna radial head usually reduces and open reduction of radial head is rarely needed, failure to align ulna will lead to chronic dislocation of radial head, treatment based on involved components (radial head, coronoid, LCL), if no improvement obtain nerve conduction studies, usually caused by failure to obtain anatomic alignment of ulna, If diagnosis is delayed greater than 2-3 weeks complication rates increase significantly, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Persistent posterior interosseous nerve palsy associated with a chronic type I Monteggia fracture-dislocation in a child: a case report and review of the literature. Compartment Syndrome in Operatively Managed Pediatric Monteggia Fractures and Equivalents. (26/80), Level 4 AP and lateral radiographs reveal a proximal ulnar shaft fracture, 30 degrees apex anterior, and a radial head dislocation. (1/8), Undecided (0/1), Level 5 2020 Oct 1. The ulna was fixed with a tension band-wire construct supplemented with screws in three patients (all of whom had a Bado type-II fracture). J Pediatr Orthop 2017: 37(6): e335-e341.Penrose JH. (16/80), Level 5 Most nerve injuries are neurapraxias and typically resolve over a period of 4-6 months. [QxMD MEDLINE Link]. [9] and Penrose in 1951 Surgical Management of Missed Pediatric Monteggia Fractures: A Systematic Review and Meta-Analysis. Indications for treatment of Monteggia fractures (seeTreatment) are based on the specific fracture pattern and the age of the patient (ie, pediatric or adult). Unstable fracture-dislocations of the forearm (Monteggia and Galeazzi lesions). 3rd ed. 1949;31B:578-88. Fracture of the upper end of the ulna associated with dislocation of the head of the radius in children. Tan JW, Mu MZ, Liao GJ, Li JM. Are you sure you want to trigger topic in your Anconeus AI algorithm? Events Search Events ; All Events List All Events Calendar Trauma Spine Shoulder & Elbow Knee & Sports Pediatrics Recon Hand . What preoperative planning is required for surgical treatment of. Bado type I lesion. J Bone Joint Surg Br. Philadelphia: Lippincott Williams & Wilkins; 2012: 351-65. - Giovanni Monteggia (1814) first described frx of proximal 1/3 of ulna in association w/ anterior dislocation of radial head; - hence dislocation of radial head w/ frx of proximal 1/3 of ulna is known as Monteggia's deformity. Diagnosis can be made with plain radiographs of the elbow. Application of this eponym to all injuries with radiocapitellar subluxation or dislocation has led to some confusion. Monteggia Fractures in the pediatric population are defined as proximal ulna fractures or plastic deformation of the ulna with an associated radial head dislocation. - associated nerve injury: Hume fracture - fracture of the olecranon accompanied by anterior dislocation of the radial head. 64 (6):857-63. Acta Orthop Belg. Soni JF, Valenza WR, Pavelec AC. Leonidou A, Pagkalos J, Lepetsos P, Antonis K, Flieger I, Tsiridis E, et al. Splinting of the wrist in extension and finger range-of-motion (ROM) exercises help prevent contractures from developing while the patient awaits resolution of the nerve injury. - Plating Techniques 2012 Feb. 35 (2):138-44. - Giovanni Monteggia (1814) first described frx of proximal 1/3 of ulna in association w/ (0/1), Level 2 (0/8), Level 1 Pediatric Monteggia fractures: amulticenter examination of treatment strategy and early clinical and radiographic results. Stitgen A, McCarthy JJ, Nemeth BA, Garrels K, Noonan KJ. The notoriously poor results of treatment of Monteggia fractures in adults improved dramatically after the development of modern techniques of plate-and-screw fixation, which facilitate early mobilization by ensuring anatomic reduction. [QxMD MEDLINE Link]. Murali Poduval, MBBS, MS, DNB Orthopaedic Surgeon, Senior Consultant, and Subject Matter Expert, Tata Consultancy Services, Mumbai, India Introduction Giovanni Battista Monteggia, a surgical pathologist and public health official in Milan, first described the Monteggia fracture in 1814. - frx of proximal 1/3 of radius & frx of ulna at the same level; - Exam: Undecided Waters PM. 32 (4):352-6. - fracture of ulnar metaphysis; In a study evaluating long-term clinical and radiographic outcomes after open reduction for missed Monteggia fracture-dislocations in 22 children (14 boys, 8 girls; age range, 4 y to 15 y 11 mo), Nakamura et al noted that the postoperative Mayo Elbow Performance Index (MEPI) at follow-up ranged from 65 to 100, with 19 excellent results, two good results, one fair result, and zero poor results. Radial head dislocation may lead to radial nerve injury. 8 (6):LC01-4. there may be slow and progressive shortening and angulation; Stable anatomic reduction of the ulnar fracture results in anatomic reduction of the radial head. [11, 12] Of the Monteggia fractures, Bado type I has been reported to be the most common (59%), followed by type III (26%), type II (5%), and type IV (1%). 16 (3):131-5. A review of the complications. The Monteggia fracture is a fracture of the proximal third of the ulna with dislocation of the proximal head of the radius. The result was excellent for eighteen patients, good for twenty-two, fair for two, and poor for six. - bony ankylosis may be more disabling than the joint instability The radial head should point towards the capitellum on all radiographs of the elbow. Children (Basel). The radius and ulna are closely invested by the interosseous membrane, which accounts for the increased risk of displacement or injury to the radius when the ulna fractures. Must have high index of suspicion high incidence of missed injuries (Waters, 2010), Appropriate radiographic imaging is essential to making the correct diagnosis, Be aware of plastic deformation of the ulna. "A Monteggia fracture with apex anterior ulnar shaft fracture is associated with an anterior radial head dislocation. Cao YQ, Deng JZ, Zhang Y, Yuan XW, Liu T, Li J, et al. [14]. 2015 Nov. 31 (4):565-80. There were twenty-five women and twenty-three men, and the average age was fifty-two years (range, eighteen to eighty-eight years). Late reconstruction of chronic Monteggia lesions in children can be complicated and unpredictable.