Typical pathological changes of NMF include malunion and angulation of the ulna, refractory dislocation of the radial head, and soft tissue injury ( 1, 2, 3, 33, 39, 43, 58, 59, 60, 61). ( 56, 57) which accommodates the unique features of pediatric Monteggia lesions. Another alternative classification system was proposed by Letts et al. The biomechanics of this subset is similar to subset I, while the radial fracture could be a secondary injury ( 50, 52, 55). (IV) Concomitant fracture of the radius with dislocation of the radial head in any direction, with or without dislocation of the PRUJ. Subset III is mainly due to a strike from the medial aspect of the elbow. (IIIa) Apex posterior fracture of ulna, and posterior dislocation of the radial head without dislocation of the PRUJ (IIIb) apex posterior fracture of ulna and posterior dislocation of the radial head with dislocation of the PRUJ. Longitudinal force during elbow flexion may be the cause of this subset, similar to the mechanism of posterior dislocaiton of the elbow, though the humeroulnar ligament is often intact. (II) Metaphyseal fracture of ulna with posterior angulation, and posterior dislocation of the radial head without dislocation of the PRUJ. The biomechanics of this subset of Monteggia fracture is that a direct blow to the posterior ulna, or extreme pronation of the forearm or over-extension of the elbow during the fall induces contract of biceps muscle and consequent fracture and dislocation. Thus, subsets of the Monteggia fracture were reestablished as follows: (I) diaphyseal fracture of ulna with anterior angulation, and anterolateral dislocation of the radial head without dislocation of the PRUJ. However, the injury of the proximal radioulnar joint (PRUJ) is ignored under this classification system, which leads to limited prognostic prediction ( 1, 3, 31, 35, 54). Classification and biomechanics of Monteggia injuryīado classification was once the most widely utilized classification for Monteggia fracture, whose occurrence is shown in Table 1 ( 52, 53).
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