summary Monteggia Fractures in the pediatric population are defined as proximal ulna fractures or plastic deformation of the ulna with an associated radial head dislocation. Diagnosis can be made with plain radiographs of the elbow. Treatment may be closed reduction and casting for length stable ulna fractures with a stable radiocapitellar joint. Surgical management is indicated for radial heads that are not stable following closed reduction. Epidemiology Demographics 4 to 10 years of age is peak incidence Etiology Definition radial head dislocation plus proximal ulna fracture or plastic deformation of the ulna without obvious fracture Classification Bado Classification Type I Apex anterior proximal ulna fracture with anterior dislocation of the radial head Type II Apex posterior proximal ulna fracture with posterior dislocation of the radial head Type III Apex lateral proximal ulna fracture with lateral dislocation of the radial head Type IV Fractures of both the radius and ulna at the same level with ananterior dislocation of the radial head (1-11% of cases) Presentation Symptoms pain, swelling, and deformity about the forearm and elbow Physical exam must palpate over radial head with all ulna fractures because spontaneous relocation of radial head is common must examine for plastic deformation of the ulna if there is a presumed isolated radial head dislocation isolated radial head dislocations almost never occur in pediatric patients Imaging Radiographs obtain elbow radiographs for all forearm fractures to evaluate for radial head dislocation assess radiocapitellar line on every lateral radiograph of the elbow login to view 1 more bullet obtain forearm radiographs for all radial head dislocations Treatment Nonoperative closed reduction of ulna and radial head dislocation and long arm casting indications login to view 3 more bullets reduction technique login to view 4 more bullets immobilization login to view 3 more bullets Operative pinning/nailing of ulna + reduction of radial head ± annular ligament repair/reconstruction indications login to view 7 more bullets technique login to view 2 more bullets ORIF similar to adult treatment indications login to view 1 more bullet