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Monteggia lesion is a traumatic condition that affects the forearm and is characterized by the association of an ulna fracture with a dislocation of the radius capitellar and proximal radius ulnar joints in the majority of cases. Although several authors have contributed to the understanding of this pathology over the years, it remains a challenge for orthopedists, and if not recognized and treated properly, it can have serious consequences. In these cases, a chronic injury develops, which is even more difficult to manage in terms of timing and treatment options. A narrative review of the literature on missed elbow injuries in children was conducted, and chronic Monteggia was the most frequently encountered injury. The analysis of the articles attempts to clarify some points and draw general conclusions on which to reflect.

Missed Monteggia fracture leading to chronic radial head dislocation is a known complication. The surgical treatment options remain challenging. The aim of treatment is to reduce the radial head and to maintain the stability of the elbow in all ranges of motion. A few surgical techniques have been described with complications. We report the case of a 13 years old boy with chronic radial head dislocation as a result of an unrecognised Monteggia fracture-dislocation for eight years. We successfully reduced the radial head and corrected the cubital valgus from 45 degrees to 10 degrees with a proximal ulna osteotomy and gradual distraction with 2-pin Monotube external fixator. The correction was uneventful with good functional outcome.