Type IV Monteggia fracture in a child.

A 12-year-old boy suffered injuries to his left forearm and elbow in a fall from a bicycle. Radiographs of the left elbow and forearm revealed a type IV Monteggia lesion (Fig. 1). During close manipulation, the greenstick radial fracture became partially displaced. However, length of the ulna and its alignment together with reduction of the radial head were satisfactorily obtained. Thereafter, the fractures were splinted in an above-elbow plaster of Paris cast with the elbow in 110° flexion. The radial head reduction was monitored by serial radiography weekly for 3 weeks. After removal of the cast, the limb was actively mobilized. When last seen 2 years after the injury, the boy had painless, normal left elbow function (Fig. 2).