Original Article

Functional Outcome of Bell Tawse Procedure for the Management of

Chronic Unreduced Monteggia Fracture-Dislocation in Children

Abstract E G Mohan Kumar,

Aim of Study: Unreduced or missed Monteggia fracture-dislocation after 4 weeks is a common G M Yathisha
presentation in a tertiary care center. The aim of this study is to study the functional outcome of Kumar,
Bell Tawse procedure for the management of chronic unreduced Monteggia fracture-dislocation in
children. Materials and Methods: In this retrospective study with prospective data collection, Mohammed
17 children were treated with open reduction of the radial head and annular ligament reconstruction Noorudheen
(Bell Tawse) combined with ulnar osteotomy. The cases were classified based on Bado’s classification. Department of Orthopedic
The minimum period of followup was 14 months and maximum followup was 18 months with the Surgery, KIMS Al Shifa
mean period of followup of 16.2 months. Preoperative and postoperative Mayo Elbow Performance Hospital, Perinthalmanna,
Kerala, India
Index (MEPI) scores were calculated. We also compared the preoperative and postoperative Kim’s
elbow functional scores. Results: At the final followup, the radial head was maintained in a completely
reduced position in 16 children. Mean preoperative MEPI score was 76.76 and mean postoperative
score was 91.11, which was statistically significant (P < 0.001). Mean preoperative Kim’s score was
76.94 and mean postoperative score was 91.35, which was also statistically significant (P < 0.001).
One girl had a mild subluxation of the radial head at 1-year followup. The ulnar osteotomy was
united in all 17 children, and none of them required secondary procedures. We have not identified any
complications such as compartment syndrome, infection, posterior interosseous nerve palsy, avascular
necrosis of the radial head, or loss of range of motion. Conclusion: We recommend ulnar osteotomy,
open reduction of the radial head, and annular ligament reconstruction in children with unreduced
Monteggia fracture-dislocation before long term complications sets in.

Keywords: Annular ligament reconstruction, Bell Tawse, cubitus valgus, radial head dislocation,
unreduced Monteggia fracture

Introduction the radial head, repair or reconstruction of

the annular ligament, temporary fixation
Unreduced or missed Monteggia fracture-
of the radial head with a transarticular
dislocation after 4 weeks is a common
wire, or some combination of these
presentation in a tertiary care center,
techniques.3,5-17 Numerous complications of
especially in India. The most common
such procedures have been reported which
reason is misdiagnosis at primary
include subluxation and redislocation,
presentation and failure to identify the radial
stiffness, elbow instability, nonunion of the
head dislocation. Usually, these children
osteotomies, avascular necrosis (AVN) of
notice deformity after 2 months of injury
the radial head, nerve injury, degenerative
while mobilizing the elbow after initial Address for correspondence:
arthritis, and infection.9,11,16,18-22
immobilization. These children present with Dr. G M Yathisha Kumar,
instability, progressive deformity of the The objective of our retrospective study Department of Orthopedic
Surgery, KIMS Al Shifa
elbow usually valgus deformity, and in few was to evaluate the clinical and radiological Hospital, Perinthalmanna,
cases, tardy ulnar nerve palsy.1-4 outcomes of patients who were treated with Kerala, India.
Bell Tawse procedure (ulnar osteotomy E-mail: yathishishere@gmail.
Delayed recognition of a Monteggia fracture com
and radial head open reduction and annular
continues to pose a treatment challenge,
ligament reconstruction).
as evidenced by the numerous surgical
techniques that have been described. The Materials and Methods Access this article online
various procedures include ulnar and radial Website: www.ijoonline.com
osteotomies, open or closed reduction of This retrospective study with prospective
DOI:
data collection was approved by our 10.4103/ortho.IJOrtho_47_19

This is an open access journal, and articles are distributed

hospital ethical committee. 21 children Quick Response Code:
under the terms of the Creative Commons Attribution-
NonCommercial-ShareAlike 4.0 License, which allows others
to remix, tweak, and build upon the work non-commercially, How to cite this article: Mohan Kumar EG,
as long as appropriate credit is given and the new creations Yathisha Kumar GM, Noorudheen M. Functional
are licensed under the identical terms. outcome of bell tawse procedure for the management
of chronic unreduced monteggia fracture-dislocation
For reprints contact: [email protected] in children. Indian J Orthop 2019;53:745-50.

© 2019 Indian Journal of Orthopaedics | Published by Wolters Kluwer - Medknow 745

 Kumar, et al.: Bell Tawse procedure in chronic unreduced Monteggia fracture‑dislocation

with neglected Monteggia fracture were treated with ulnar postoperative Kim’s elbow functional scores.25 The Kim’s
osteotomy and open reduction of the radial head along with index is based on four parameters: deformity, pain, the
reconstruction of annular ligament (Bell Tawse). The study range of motion, and function. These four parameters are
period was between July 2010 and July 2017. Children who weighted equally, giving 25 points to each parameter, for a
presented at least 2.5 months after injury were included total score of 100 points.26
in the study. Patients who lost followup were excluded.
All radiologic measurements were performed including
The cases were classified based on Bado’s23 classification.
deformity of the radial head, osteoarthritic changes,
Indication for surgery was children with unreduced
and congruency of the radiocapitellar joint which were
radial head dislocation with malunited ulna fracture and
evaluated with routine preoperative [Figure 1d] and
progressive valgus deformity. All patients had a history of
postoperative serial radiographs. The final reduction
trauma involving the ipsilateral elbow or forearm and were
status of the radial head was divided into three categories:
treated with Plaster of Paris immobilization or indigenous
good (complete reduction without osteolytic change), fair
management or splinting and referred from other hospitals.
(reduction with subluxation or osteolytic change), or poor
All 21 children complained of deformity associated with
(radial head dislocation).27
instability of elbow, few children had limitation of range
of motion of elbow and none of the patients had signs of Surgical technique
neuropathy or a history of previous elbow surgery. A total
All operations were performed by the senior author. We
of 21 cases were operated during this period and complete
performed an open reduction through a Boyd and Speed
follow was available in 17 children with 11 boys and 6
approach. This approach has the advantage of doing the
girls, the remaining 4 cases were lost to follow-up. The
ulnar osteotomy and open reduction of the radial head
minimum period of followup was 14 months and maximum
using a single incision. For reconstruction of the annular
followup was 2 years with the mean period of followup
ligament, a 10-cm long central slip of triceps aponeurosis
of 16.2 months. The mean age of the patients at operation
was fashioned (Bell Tawse) of 0.5-cm breadth from
was 6.61 ± 1.49 years. The right elbow was involved in 10
proximal to distal. Care is taken not to detach its insertion
patients and the left was injured in 7. The mean interval
at the ulna. Now, periosteum was stripped from ulna at
from injury to surgery was 3.52 months (range between 3
the site of osteotomy. A low-energy osteotomy of the ulna
and 5 months). None of the children had preoperative ulnar
was performed at the apex of the deformity, usually about
nerve palsy.
5 cm from the olecranon by making multiple drill holes,
All patients were checked for elbow pain, the range of and completes the osteotomy with a bone cutter [Figure 2a].
elbow movement, carrying angle, valgus instability, and The radiocapitellar joint was opened, the radial head
any disabilities in daily life [Figure 1a-c]. Preoperative was exposed, any fibrous tissue hindering the reduction
and postoperative Mayo Elbow Performance Index (MEPI) was excised, and we assessed the state of the cartilage of
scores were calculated from the data in the medical records the radial head. Carefully, the aponeurosis was wrapped
for all patients.24 We also compared the preoperative and around the radial neck before reduction of the radial

a b c d
Figure 1: (a) Preoperative cubitus valgus deformity, (b) restricted flexion of the left elbow, (c) hyperextension, (d) preoperative X-ray showing malunited
ulna with radial head dislocation

a b c d
Figure 2: (a) Low-energy osteotomy of the ulna by making multiple drill holes, (b) the aponeurosis wrapped around the radial neck, (c) reconstructed
annular ligament, (d) osteotomy site angulated and fixed with DCP

746 Indian Journal of Orthopaedics | Volume 53 | Issue 6 | November-December 2019

 Kumar, et al.: Bell Tawse procedure in chronic unreduced Monteggia fracture‑dislocation

head [Figure 2b and c]. Using forearm bone holder, both ranges of motion in all patients. At the final followup, the
ulnar fragments were held in angulation and distraction elbow was stable in all 16 children.
until the radial head reduced without any tension, and the
The ulnar osteotomy site was united in all 17 children,
ulna was fixed in the same angulation using a prebent 3.5
and none of them required secondary procedures. One
system 5-hole dynamic compression plate with a pair of
girl developed anterior subluxation of the radial head at
screws holding on either side ensuring contact between the
1-year followup, she had 10° of restriction of flexion with
fragments (open wedge osteotomy) [Figure 2d]. The range of
full range of rotation of the forearm, and mild instability
angular correction performed was 10°-30°. Additional bone
was noted. Ten children had hypertrophic scar, but none of
grafting was not performed in any patients. Now, the end
the children complained about the cosmetic problem. We
of the tricipital aponeurosis was sutured to nondetached end have not identified any complications such as compartment
of the aponeurosis using a nonabsorbable suture material. If syndrome, infection, posterior interosseous nerve palsy, or
the distal attachment is torn, then the author recommends AVN radial head.
to make a drill hole on the ulna and aponeurosis secured to
the ulna. Care was taken not to tension the graft around the Discussion
radial neck. Stability of the radial head was checked, and
postoperatively, an above elbow slab was applied to all the Missed Monteggia fracture-dislocation in children is
patients with the elbow in 90° of flexion, and the forearm common in India due to the traditional method of treatment
was maintained in a neutral position for 5 weeks in all by bone setters and missing the radial head dislocation by
patients. After removal of the slab, we encouraged gentle orthopedists. Forced hyperpronation ruptures the capsule and
active movement of the elbow. annular ligament, followed by a fracture to the ulna shaft
and finally rotation of the radial head, so it lies anterior to
Statistical analysis the capsule.5 The interposed capsule and shortening can
The statistical software, namely the Statistical Package for prevent reduction of the radial head causing it to act as a
the Social Sciences (version 15.0, SPSS Inc., 233 South mechanical block to full flexion demanding open reduction.
Wacker Drive, 11th Floor, Chicago, IL 60606-6412, USA), Mal-union of the fracture ulna in shortening and angulation
was used for the analysis of the data, and Microsoft Word which further prevent reduction of the radial head until
and Excel was used to generate tables and figures. The the deformity of the ulna is corrected. If left unreduced,
t-student test was used for mean comparison between the this can result in restricted flexion, unstable cubitus valgus,
preoperative and postoperative groups. and ultimately, a painful arthritic elbow due to secondary

Results Table 1: Comparison between pre- and postoperative

Of the 17 children who were studied, all of them had Mayo Elbow Performance Index score
undergone ulnar angular osteotomy and open reduction MEPI score Mean±SD P
of the radial head with annular ligament reconstruction. Preoperative 76.76±1.71 <0.001**
Intraoperatively, articular cartilage of the radial head and Postoperative 91.11±1.11
capitellum was normal in all 17 cases. At the final followup, Paired t-test. **P<0.001=Highly significant. SD=Standard
the radial head was maintained in a completely reduced deviation, MEPI=Mayo Elbow Performance Index
position in 16 (94%) children [Figures 3 and 4]. Mean
preoperative MEPI score was 76.76 and mean postoperative Table 2: Comparison between pre- and postoperative
score was 91.11, which was statistically significant Kim’s score
(P < 0.001)28 [Table 1 and Figure 5a]. Mean preoperative Kim’s score Mean±SD P
Kim’s score was 76.94 and mean postoperative score Preoperative 76.94±2.24 <0.001**
was 91.35, which was also statistically significant Postoperative 91.35±1.27
(P < 0.001) [Table 2 and Figure 5b]. We found a significant Paired t-test. **P<0.001=Highly significant. SD=Standard
improvement between preoperative and postoperative elbow deviation

a b c d
Figure 3: (a) Preoperative X-ray showing unreduced Monteggia fracture-dislocation, (b) postoperative X-ray at 1-year followup, (c) at 1-year followup
deformity well corrected with full extension, (d) full flexion

Indian Journal of Orthopaedics | Volume 53 | Issue 6 | November-December 2019 747

 Kumar, et al.: Bell Tawse procedure in chronic unreduced Monteggia fracture‑dislocation

a b c d e
Figure 4: (a) Preoperative X-ray, (b) post of X-ray at 1-year followup, (c) 2-year followup, (d and e) range of movement at 2-year followup

a b
Figure 5: (a) Comparison between preoperative and postoperative Mayo Elbow Performance Index scores, (b) comparison between preoperative and
postoperative Kim’s score

degenerative changes.7 Sometimes, cubitus valgus deformity slip of the triceps tendon in their sample of eight patients.3
can progress resulting in tardy ulnar nerve palsy. Reduction of the radial head was held using a transarticular
Kirschner wire. The reason for using a lateral slip of the
Bell Tawse originally described his technique for the
triceps tendon was because it has a rolled edge and is more
treatment of malunited anterior Monteggia fractures in
substantial than the central slip. It is also anatomically
1965.12 Using a posterolateral approach, the interposed
closer to the radial head. They concluded that triceps slip
capsular block is exposed and removed from the
was preferable to palmaris tendon grafting as it avoids
radiocapitellar joint. The radial head can then be easily
unnecessary donor-site morbidity and also that Kirschner
reduced without the need to divide the ulna. Bell Tawse
wire fixation seems essential to prevent subluxation or
described reconstruction of the annular ligament by turning
recurrent dislocation.
down a slip of the triceps tendon (middle portion of the
tendon), leaving it attached to the ulna, and passing it Several authors insist that Annular ligament
around the neck of the radius from behind forward and reconstruction is crucial for the stability of the radial head
securing it through a drill hole in the ulna. Rehabilitation and are concerned about the lack of stability of the radial
included 6-week immobilization in full extension and head without reconstruction of the annular ligament.17,25,29
supination, followed by gradual mobilization. In their Few studies found that ALR was not mandatory.5,28-31
sample of six children, the reduction was easily achieved Complications, including osteolytic changes, narrowing of
with good long term followup results. Annular ligament the radial neck, growth disturbance, heterotopic ossification,
reconstruction seems to be a simple and reproducible and osteonecrosis of the radial head, have been reported
technique with overall good success rates reported.10,13 after ALR.11,19,22,29,32,33
Since the originally described technique, several variations In our series, we reconstructed annular ligament using
have been published in the literature. Lloyd-Roberts and a central slip of triceps (Bell Tawse) and securing it on
Bucknill described reconstruction of the annular ligament ulna using a drill hole after reduction of the radial head
using either a free palmaris longus tendon graft or a lateral combined with ulnar osteotomy. Care was taken to avoid

748 Indian Journal of Orthopaedics | Volume 53 | Issue 6 | November-December 2019

 Kumar, et al.: Bell Tawse procedure in chronic unreduced Monteggia fracture‑dislocation

excessive tightness and tension of the annular ligament The limitations of our study are that it is a retrospective
around the radial neck to avoid complication associated one without randomization, and our sample size was small.
with it. During the postoperative period, we immobilized However, our number of cases (17 cases) was similar to the
elbow in 90° flexion and midprone position avoiding size of the cohort of most previous studies. Third, although
transcapital pinning. We have achieved a full range of MEPI has presently been validated only in adults, there is
motion except one girl who had a mild anterior subluxation no elbow score for children, and therefore, we used MEPI.
of the radial head with terminal restriction of flexion. Her To compensate for this limitation, we used an additional
parents were informed regarding recurrence and warned functional outcome measure proposed by Kim et al.26
regarding resurgery; as it was a nondominant side, she is
not having any limitations of activities of daily living. We Conclusion
are closely following her. Missed Monteggia fracture-dislocation in children is
Hirayama et al.11 used an ulnar osteotomy with common in India. Chronic unreduced Monteggia fracture-
overcorrection and elongation aiming to maintain the dislocation leads to progressive cubitus valgus deformity
reduced position of the radial head through the stabilizing in children ultimately resulting in degenerative joint and
action of the interosseous membrane.11 Ulnar osteotomy has tardy ulnar nerve palsy; furthermore, there is a constant
been recommended as a key procedure in the treatment of issue of loss of lateral support and valgus instability. Torn
missed Monteggia fracture and is based on the hypothesis annular ligament and malunited shortened ulna in volar
that the primary problem is malunion of the ulna angulation prevent radial head reduction. Open reduction is
preventing reduction of the radial head.5,29,30 The osteotomy indicated as early as possible before degenerative changes
is performed 5 cm below the olecranon, distracted by up to and adaptive changes make complete disorganization of the
1 cm, and fixed with a 15° posterior angulated plate. They biomechanics of the elbow and function. Removal of fibrous
described good results in their series of nine patients, and tissue hindering reduction of radial head and reversing
if the radial head is not manually reducible due to excess the ulnar angulation and gaining the length by osteotomy
deformity or chronicity of the injury, then ulnar osteotomy allow radial head reduction without much tension. Annular
allows reduction to be achieved. This technique has also ligament reconstruction prevents instability of the radial
been supported in the more recent literature,7,10,16 and some head and recurrence. We recommend ulnar osteotomy,
authors advocate that annular ligament reconstruction open reduction of the radial head, and annular ligament
is only required if the radial head remains unstable reconstruction in all children with unreduced Monteggia
intraoperatively.16,17 There are several complications related fracture-dislocation before long term complications sets in.
to ulnar osteotomy, including delayed union, nonunion, Declaration of patient consent
fixation failure, and negative cosmetic problems.11,22
The authors certify that they have obtained all appropriate
There are studies in the literature with recurrence of the patient consent forms. In the form the patients have given
dislocation in cases without ulnar osteotomy. In our series, their consent for their images and other clinical information
we did ulnar osteotomy in all cases. The osteotomy was to be reported in the journal. The patients understand that
done at around 5 cm from the olecranon or at the site of their names and initials will not be published and due
fracture malunion. Once the ulnar osteotomy was performed efforts will be made to conceal their identity, but anonymity
soft tissue preventing radial head reduction was excised cannot be guaranteed.
and the osteotomy was fixed using a dynamic compression
Acknowledgment
plate (5-hole 3.5 system) in a angulation where radial
head reducible and stable. We have noticed that the radial Sincere acknowledgement to Dr Shabir Ali, Dr Thomas
head was reducible by angulating the ulna (dorsally open Varghis, Dr Ajay Kumar, all PG students, Umaiva,
wedge) at the osteotomy site in all cases without doing any Manikandan, Viji sister, Faisal Babu, Sreejith for making
distraction. Care was taken to close the periosteum whatever substantial contributions to this study.
possible, and none of the cases required a bone graft for the Financial support and sponsorship
union. All osteotomies were united at 10-week followup.
We had warned all parents regarding the cosmetic issue Nil.
due to ulnar osteotomy preoperative, so none of patients Conflicts of interest
complained about surgical scar during postoperative period
in spite of 10 children developed hypertrophic scar. There are no conflicts of interest.

At the final followup, we noticed excellent functional References

outcome in all patients treated with statistically significant 1. Bhaskar A. Missed Monteggia fracture in children: Is annular
improvement in pre- and postoperative MEPI and Kim’s ligament reconstruction always required? Indian J Orthop
score. Results of our study were comparable with articles 2009;43:389-95.
published in the literature. 2. Horii E, Nakamura R, Koh S, Inagaki H, Yajima H, Nakao E.

Indian Journal of Orthopaedics | Volume 53 | Issue 6 | November-December 2019 749

 Kumar, et al.: Bell Tawse procedure in chronic unreduced Monteggia fracture‑dislocation

Surgical treatment for chronic radial head dislocation. J Bone 1997;(342):94-8.

Joint Surg Am 2002;84-A:1183-8. 19. Kalamchi A. Monteggia fracture-dislocation in children. Late
3. Lloyd-Roberts GC, Bucknill TM. Anterior dislocation of the treatment in two cases. J Bone Joint Surg Am 1986;68:615-9.
radial head in children. The Journal of Bone and Joint Surgery 20. Oner FC, Diepstraten AF. Treatment of chronic posttraumatic
1977;59-B(4):402-7. dislocation of the radial head in children. J Bone Joint Surg Br
4. Di Gennaro GL, Martinelli A, Bettuzzi C, Antonioli D, Rotini R. 1993;75:577-81.
Outcomes after surgical treatment of missed Monteggia fractures 21. Rodgers WB, Waters PM, Hall JE. Chronic monteggia lesions
in children. Musculoskelet Surg 2015;99 Suppl 1:S75-82. in children. Complications and results of reconstruction. J Bone
5. Bell Tawse AJ. The treatment of malunited anterior Monteggia Joint Surg Am 1996;78:1322-9.
fractures in children. J Bone Joint Surg Br 1965;47:718-23. 22. Verneret C, Langlais J, Pouliquen JC, Rigault P. Old
6. De Boeck H. Treatment of chronic isolated radial head posttraumatic dislocation of the radial head in children. Rev Chir
dislocation in children. Clin Orthop Relat Res 2000;(380):215-9. Orthop Reparatrice Appar Mot 1989;75:77-89.
7. Degreef I, De Smet L. Missed radial head dislocations in 23. Bado JL. The Monteggia lesion. Clin Orthop Relat Res
children associated with ulnar deformation: Treatment by open 1967;50:71-86.
reduction and ulnar osteotomy. J Orthop Trauma 2004;18:375-8. 24. Morrey BF. Functional evaluation of the elbow. In: Morrey BF,
8. Devnani AS. Missed Monteggia fracture dislocation in children. Sanchez-Sotelo J, editors. The Elbow and its Disorders. 2nd ed.
Injury 1997;28:131-3. Philadelphia: Saunders/Elsevier; 1993. p. 86-97.
9. Futami T, Tsukamoto Y, Fujita T. Rotation osteotomy for 25. Cappellino A, Wolfe SW, Marsh JS. Use of a modified bell tawse
dislocation of the radial head 6 cases followed for 7 (3-10) years. procedure for chronic acquired dislocation of the radial head.
Acta Orthop Scand 1992;63:455-6. J Pediatr Orthop 1998;18:410-4.
10. Hasler CC, Von Laer L, Hell AK. Open reduction, ulnar 26. Kim HT, Park BG, Suh JT, Yoo CI. Chronic radial head
osteotomy and external fixation for chronic anterior dislocation dislocation in children, part 2: Results of open treatment and
of the head of the radius. J Bone Joint Surg Br 2005;87:88-94. factors affecting final outcome. J Pediatr Orthop 2002;22:591-7.
11. Hirayama T, Takemitsu Y, Yagihara K, Mikita A. Operation for 27. Nakamura K, Hirachi K, Uchiyama S, Takahara M, Minami A,
chronic dislocation of the radial head in children. Reduction by Imaeda T, et al. Long term clinical and radiographic outcomes
osteotomy of the ulna. J Bone Joint Surg Br 1987;69:639-42. after open reduction for missed Monteggia fracture-dislocations
12. Hui JH, Sulaiman AR, Lee HC, Lam KS, Lee EH. Open in children. J Bone Joint Surg Am 2009;91:1394-404.
reduction and annular ligament reconstruction with fascia of 28. Dahiru T. P – value, a true test of statistical signifi cance?
the forearm in chronic Monteggia lesions in children. J Pediatr A cautionary note. Annals of Ibadan postgraduate medicine.
Orthop 2005;25:501-6. 2008;6:21-6.
13. Hurst LC, Dubrow EN. Surgical treatment of symptomatic 29. Gyr BM, Stevens PM, Smith JT. Chronic Monteggia fractures in
chronic radial head dislocation: A neglected Monteggia fracture. children: Outcome after treatment with the bell-tawse procedure.
J Pediatr Orthop 1983;3:227-30. J Pediatr Orthop B 2004;13:402-6.
14. Seel MJ, Peterson HA. Management of chronic posttraumatic 30. Lloyd-Roberts GC, Bucknill TM. Anterior dislocation of
radial head dislocation in children. J Pediatr Orthop the radial head in children: Aetiology, natural history and
1999;19:306-12. management. J Bone Joint Surg Br 1977;59-B:402-7.
15. Wattincourt L, Seguin A, Seringe R. Old Monteggia lesions in 31. Lädermann A, Ceroni D, Lefèvre Y, De Rosa V, De Coulon G,
children. Apropos of 14 cases. Chir Main 1999;18:137-48. Kaelin A. Surgical treatment of missed Monteggia lesions in
16. Mehta SD. Flexion osteotomy of ulna for untreated. Strategies children. J Child Orthop 2007;1:237-42.
Trauma Limb Reconstr 2007;2(1):31-4. 32. Oner FC, Diepstraten AF. Treatment of chronic posttraumatic
17. Best TN. Management of old unreduced Monteggia fracture dislocation of the radial head in children. J Bone Joint Surg Br
dislocations of the elbow in children. J Pediatr Orthop 1993;75:577-81.
1994;14:193-9. 33. Fowles JV, Sliman N, Kassab MT. The Monteggia lesion in
18. De Boeck H. Radial neck osteolysis after annular ligament children. Fracture of the ulna and dislocation of the radial head.
reconstruction. A case report. Clin Orthop Relat Res J Bone Joint Surg Am 1983;65:1276-82.

750 Indian Journal of Orthopaedics | Volume 53 | Issue 6 | November-December 2019