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In an analysis of 29 cases of three different Monteggia-type fractures in children, the mechanism of injury was a hyperpronation force on the extended elbow. The follow-up period ranged from one to three years with a mean of 18 months. Closed reduction of these fractures was always difficult to maintain because the lesions are unstable. Closed reduction was successful in 25 of the 29 cases and open reduction was required in four. A slight residual dorsal angulation remained in 18 cases with fracture of both bones of the forearm, but healing in this position was acceptable.

Trauma to the extremities is sometimes dismissed as relatively unimportant in certain radiologic circles. In many instances, radiologic responsibility is denied and relegated to the orthopedist. Although the radiologic manifestations of much trauma to the extremities is clear cut and does not require sophisticated techniques or interpretation, there are many diagnoses which require innovative techniques and a knowledge of mechanisms of injury as well as the subtle oseous and soft tissue manifestations which may be confronted radiologically. The above factors will be stressed along with the need for the fundamental knowledge of radiologic anatomy which is required in order to appreciate some of the more subtle changes of extremity trauma.

Poor results in treating fractures and dislocations about the elbow may be avoided if the surgeon is aware of the possible injuries, examines good radiographs of both elbows, and treats the injury promptly and appropriately. A displaced fracture of the lateral or medial condyle of the humerus should be suspected if there is a flake fracture of the adjoining metaphysis; open reduction and internal fixation give better results than closed reduction. A shear fracture of the capitulum humeri can only be seen on a lateral radiograph; excision of the fragment, followed by mobilization, is sufficient for a good functional result. Dislocation of the elbow in a child may avulse the medial epicondyle, which sometimes lodges in the joint; it is essential to recognize this and remove the fragment without delay to avoid early degenerative arthritis. An apparently isolated fracture of the ulna should alert the surgeon to the possibility of a dislocation of the radial head; the dislocation and the fracture must be reduced and stabilized to conserve elbow function.