Management of chronic monteggia fractures with ulnar osteotomy, external fixation and gradual closed reduction of radial head

Purpose At present, there is no standardized surgical protocol for chronic Monteggia fractures, particularly in patients who are older than 10, have missed radial head dislocation for over 1 year, or have developed radial head deformities. Current surgical approaches remain suboptimal and are often associated with poor clinical outcomes. Methods This study retrospectively analyzed 14 patients with chronic Monteggia fractures who had been managed with ulnar osteotomy, external fixation and gradual closed reduction of radial head at our institution between January 2022 and November 2025. By analyzing clinical and radiographic outcome, we systematically assessed the therapeutic effectiveness and short-term outcomes of this treatment. Results During the latest follow-up period (range: 6–42 months; median: 21.6 months), none of the 14 patients developed recurrent radial head dislocation. Five patients developed pin tract infections and two patients had mild limitation of elbow flexion and supination, but neither affected daily activities. Of note, radiographic outcome of one patient at the 3-year follow-up revealed degenerative changes in the radial head, but this patient maintained full range of motion of the elbow without experiencing pain or mobility restrictions. The remaining patients showed no significant abnormalities in both clinical and radiographic outcomes. Conclusions We recommend ulnar osteotomy, external fixation and gradual closed reduction of radial head for patients with chronic Monteggia fractures who are older than 10, have missed radial head dislocation for over 1 year, or have developed radial head deformities. This treatment ensures anatomical reduction while significantly improving surgical success rates and short-term outcomes.