Late Missed Monteggia Fractures
Even today approximately 30% of all dislocations of the radial head associated with fractures of the ulna (Monteggia lesion) are missed. There are two main pitfalls. First, there is not always an obvious fracture of the ulna. Therefore, simple bowing of the ulna may not be considered a signal for a potential dislocation of the radial head. The other pitfall is that the elbow is often not included on radiographs of the forearm. A retrospective study from 1998, including patients from 1980 to 1997, showed that only 4 of 13 patients had objectively good results and 9 of 13 patients had bad results. Decreased range of motion over 20° in any plane compared with the opposite elbow or redislocation or subluxation were rated as bad results. This disastrous experience forced us to reflect again on the issues of late missed Monteggia fractures.