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Forearm Shaft Fractures (including Monteggia and Galeazzi)

88 citationsUpdated Oct 2026
Illustration: elbow

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Forearm shaft fractures encompass isolated diaphyseal injuries of the radius or ulna, as well as complex fracture-dislocations such as Monteggia and Galeazzi patterns. Isolated radial diaphyseal fractures are more common than true Galeazzi fractures [3], while sustaining two Monteggia fractures of the same forearm is exceptionally rare, with no such case identified in literature reviews [5]. Optimal outcomes for these injuries depend on early recognition and management, with restoration and maintenance of anatomic alignment serving as the key principles [4]. Patients with open fractures or fractures of both bones lose significantly more forearm rotation irrespective of treatment [10]. Adhering to basic principles derived from the management of Monteggia and other proximal forearm fractures yields excellent clinical results in radial head dislocation with radial shaft fracture [1].

Open reduction and internal fixation is the standard of care for adult diaphyseal forearm fractures, against which all other treatments are compared [19]. Plating is a satisfactory method that leads to excellent results in a majority of patients [34], with surgical fixation for both-bone fractures resulting in good outcomes and only modest losses of strength and rotation [31]. Locking compression plates and dynamic compression plates yield similar results [26]. Closed nailing is a treatment option for any forearm shaft fracture [7], and new intramedullary nails show promising results [8]. Galeazzi injuries are unstable fracture-dislocations requiring surgical management for optimal outcomes [35]. Following open reduction and internal fixation of the radius in Galeazzi fracture-dislocations with stable distal radioulnar joints, immobilization in supination for four weeks offers no advantage over neutral immobilization for a shorter period [30]. Treatment planning must account for long-term bone atrophy after plate fixation [27], and surgical intervention in neglected diaphyseal fractures leads to satisfactory outcomes [2]. The evolution of operative treatment highlights the transition from nonsurgical methods with high complication rates to plate osteosynthesis as the surgical treatment of choice after World War II [28].

Non-operative management is appropriate for many isolated ulnar shaft fractures, which can be treated adequately by closed means using short casts [18]. In isolated ulnar shaft fractures, essentially no immobilization allows rapid healing with a lower rate of loss of forearm motion compared to literature reports [9]. Both surgical and nonsurgical management are reported as acceptable forms of treatment with high union rates and good functional outcomes [14], although a substantial percentage of these fractures do not heal successfully with nonsurgical management alone [15]. In the osteoporotic patient, an isolated ulnar shaft fracture is perhaps most safely treated in a long arm cast [6]. Postoperative films obtained within four weeks of surgery for radial shaft fractures are unlikely to change management and may not be warranted during routine follow-up [24]. Clinical studies continue to yield contradicting results, and retrospective studies are not able to solve the debate on the optimal treatment of isolated ulnar shaft fractures [16]. Expert consensus has generated a comprehensive list of 26 assessment parameters to assess surgeon performance in open reduction and internal fixation of an isolated adult ulnar shaft fracture [40].

Anatomy & Pathophysiology

Bony Anatomy and Biomechanics

The forearm enables hand positioning in space through elbow and wrist flexion/extension and pronation/supination via the proximal and distal radioulnar joints [17]. Inadequate treatment of ulnar and radial shaft fractures can result in significant functional impairment [17]. Radial shaft fractures are defined as occurring between the radial neck proximally and the junction of the metaphysis and diaphysis distally, approximately 3 cm proximal to the distal articular surface [17]. Ulnar shaft fractures are defined as occurring between the distal aspect of the coronoid proximally and the ulnar neck distally [17].

The elbow is a trocho-ginglymoid joint with trochoid (rotatory) motion through the radiocapitellar and proximal radioulnar joints and ginglymoid (hinge-like) motion through the ulnohumeral joint [79]. The ulnohumeral joint allows flexion and extension, while the radiocapitellar joint allows forearm rotation [76]. The articular surface of the distal humerus is angled 30 degrees anterior to the humeral shaft axis [74, 75]. Normal range of elbow flexion/extension is 0 to 150 degrees [74, 75], and normal forearm pronosupination is 80 to 85 degrees in each direction [74, 75]. The functional range of motion for the elbow is 30 to 130 degrees for flexion/extension and 50 degrees for pronosupination [74, 75]. In full extension, 60% of axial load is transmitted through the radiocapitellar joint [74, 75].

The radial head is a concave elliptical structure covered with articular cartilage along the radiocapitellar joint and approximately 270° of the articular margin [68]. The radius is held in close approximation to the ulna at the proximal radioulnar joint by the annular ligament [68]. The area of the ulna which articulates with the margin of the radial head at the proximal radioulnar joint is known as the lesser sigmoid notch [68]. The distal humeral articulation is angled 30° from the longitudinal axis, and the anterior humeral line should pass through the center of the axis of rotation [68]. The axis of rotation is 5° to 7° angulated in the coronal plane to the epicondylar axis, with the medial side more distal than the lateral side [68]. The ulna medially bends approximately 8° at 8 cm from the tip of the olecranon [68]. The articulation to the tip of the coronoid is approximately 30° from the long axis of the ulna in the sagittal plane [68].

The trochlea is covered by articular cartilage anteriorly, inferiorly, and posteriorly, creating an arc of almost 270 degrees [79]. The trochlea is shaped like a spool with a central sulcus which articulates with the central ridge of the greater sigmoid notch of the proximal ulna [79]. The medial column of the distal humerus diverges approximately 45 degrees from the humeral shaft in the coronal plane [79]. The lateral column of the distal humerus diverges at approximately 20 degrees from the shaft in the coronal plane [79]. The lateral column curves anteriorly creating a 35 to 40 degrees angle with the shaft in the sagittal plane [79]. In the coronal plane, the trochlea is more distal than the capitellum resulting in a valgus alignment of 4 to 8 degrees [79]. The elbow has a valgus angle in extension of 10 to 17 degrees, termed the carrying angle [79]. The distal humerus articular surface is internally rotated 3 to 8 degrees axially [79]. The olecranon fossa accepts the olecranon during extension and the coronoid fossa accepts the coronoid during flexion [79].

The radial head should line up with the capitellum at all arm positions on all radiographic views [69, 70]. Tensile forces are present at the medial elbow and compressive forces at the lateral elbow [69, 70]. The capsule allows maximum distension at approximately 70 to 80 degrees of flexion [69, 70]. The anterior capsule attaches at a point approximately 6 mm distal to the tip of the coronoid [69, 70]. The brachialis is the strongest elbow flexor and attaches to the coronoid 11 mm distal to the tip [69, 70]. The biceps brachii inserts at the ulnar margin of the radial tuberosity and is a powerful supinator of the forearm [69, 70]. The primary elbow extensor, the triceps, inserts on the olecranon process [69, 70].

Ligamentous Anatomy and Stability

Elbow stability is conferred by bony articular anatomy and ligamentous structures on the medial and lateral sides [48]. The three primary stabilizers of the elbow are the ulnohumeral articulation, the medial ulnar collateral ligament (MUCL), and the lateral ulnar collateral ligament (LUCL) complex [48]. Secondary stabilizers of the elbow include the radiocapitellar articulation, common flexor tendon, common extensor tendon, and joint capsule [48].

The medial ulnar collateral ligament is the primary valgus stabilizer [69, 70]. The anterior bundle of the medial ulnar collateral ligament is the most important component for stability and is the primary restraint to valgus stress within functional elbow range of motion [69, 70, 74, 75]. The posterior bundle of the medial ulnar collateral ligament is the primary restraint to valgus stress with the elbow in maximal flexion [74, 75]. Stability in full extension is provided by the medial collateral ligament, joint capsule, and ulnohumeral articulation [74, 75].

The lateral ulnar collateral ligament is the posterolateral stabilizer [69, 70]. The lateral collateral ligament complex consists of the radial collateral ligament, the lateral ulnar collateral ligament, and the annular ligament [79]. The annular ligament attaches to the anterior and posterior margins of the lesser sigmoid notch [79]. The radial collateral ligament originates from an isometric point on the lateral epicondyle and fans out to attach to the annular ligament [79]. The lateral ulnar collateral ligament arises from the isometric point on the lateral epicondyle and attaches to the crista supinatoris of the proximal ulna [79]. The lateral collateral ligament complex functions as an important restraint to varus and posterolateral rotatory instability [79]. The contribution of concavity-compression stability across the radiocapitellar joint to overall elbow stability is clearly demonstrated [60].

Pathophysiology and Injury Mechanisms

The forearm plays an important role in positioning of the hand in space by flexion and extension of the elbow and wrist as well as pronation and supination through the proximal and distal radioulnar joints [17]. Fractures of the ulnar and radial shaft can result in significant dysfunction if treated inadequately [17]. The direction of radial head dislocation in lateral Monteggia fractures may depend on the rotational position of the forearm at the time of the primary adduction injury [123]. Biomechanical changes in Monteggia fractures explain pathological changes in the annular ligament, where longitudinal displacement of the radial head causes it to slip out of the annular ligament while the ligament remains intact [110]. Increasing magnitudes of soft tissue disruption result in greater anterior radial head instability in anterior Monteggia injuries [107]. In cases with significant soft tissue injury in anterior Monteggia injuries, the elbow should be immobilized in a flexed and supinated position to allow relaxation of the biceps and avoid movement of the elbow in the early postoperative period [129].

The mechanism causing delayed radial head dislocation associated with malunion of radial shaft fracture involves eccentric torque on the radial head during forearm pronation resulting from malunion of the radius [116]. Inaccurate contouring of a compression plate can reverse the normal sagittal bow of the radius, generating deforming forces that lead to anterior dislocation of the distal end of the ulna in Galeazzi fractures [128]. Migration of the radius under loads in Galeazzi fracture dislocations implies disruption of both the central band and triangular fibrocartilage complex [115]. Most major traumatic plastic bowing deformities of the ulna involved rotation rather than bending [112].

Anatomic reduction of the ulna is critical to achieving a favorable outcome in complex Monteggia fractures, as it indirectly reduces the radiocapitellar joint [126]. Correction of the ulnar deformity with elongation and angulation of the ulna in the opposite direction of the dislocation of the radial head is the most important factor for the reduction and consequent preservation of the radial head in chronic Monteggia lesions [127]. Problems with the elbow related to fractures of the coronoid process and the radial head remain the most challenging elements in the treatment of Monteggia fractures [32]. The clinical outcome of posterior Monteggia fractures remains unpredictable, particularly when there is an associated radial head fracture [25]. Posterior Monteggia fractures remain a complex management problem with a fine balance between the need to ensure fracture union and the preservation of elbow function and range of movement [64]. Severe osseous, soft tissue, and neural trauma affect the functional results of the elbow region in unusual patterns of Monteggia fracture-dislocation [95]. The ulnar fracture pattern in anterior Monteggia fractures may be either a simple diaphyseal injury or a more complex metaphyseal injury which has a less favourable prognosis, in part because such injuries also involve an element of fracture dislocation at the elbow joint itself [46].

Forearm fractures were more common in snowboarders than in skiers, potentially because snowboarders have both feet fixed to the board, requiring them to break a fall with their arms [29]. The most common fractures in skiers and snowboarders were simple, isolated radial shaft fractures, which are generally very rare injuries [29]. Some simple, isolated radial shaft fractures in skiers and snowboarders may have been underdiagnosed Galeazzi subluxations [29].

Classification

General Principles: Forearm shaft fractures are classified according to location (proximal, middle, and distal third) or fracture comminution [50]. Open forearm fractures are classified according to Gustilo's classification and the OTA open fracture classification [50]. Isolated ulna fractures are classified as stable or unstable, with stable fractures defined as those with less than 50% of displacement and less than 10 degrees of angulation [50].

AO/OTA: The AO/OTA classification is the most widely used fracture classification for forearm fractures, identified by the number 22 (2 for forearm, 2 for shaft) [50]. In this system, Type A fractures are simple fractures, Type B are wedge fractures, and Type C are complex (highly comminuted or segmental) fractures [50]. Type A and B fractures involve either the ulna (types A1, B1), the radius (types A2, B2), or both bones (types A3, B3) [50]. Type C fractures involve both bones, with a simple fracture of the radius and segmental comminution of the ulna in type C1, a simple fracture of the ulna and segmental comminution of the radius in type C2, and segmental comminution of both bones in type C3 [50]. Monteggia fractures are classified as types A1.3 and B1.3 depending on whether the ulnar fracture is simple or wedged [50]. Monteggia fracture dislocations in which both the radius and ulna are fractured are classified as type A3.2 or B3.2 [50]. Galeazzi fracture dislocations are classified as types A2.3 and B2.3 depending on whether the radial fracture is simple or wedged [50]. Galeazzi fracture dislocations in which both the radius and ulna are fractured are classified as type A3.3 or B3.3 [50]. The utility of the AO/OTA system in the management of forearm fractures is restricted mainly to research purposes due to the complexity of its nomenclature and low reliability [50].

Bado: Bado established a system of classification for Monteggia lesions based on the mechanism of injury, treatment, and results [23]. Bado Type I Monteggia lesions involve a fracture of the ulnar diaphysis at any level with anterior angulation at the fracture site and an associated anterior dislocation of the radial head [23]. Bado Type II Monteggia lesions involve a fracture of the ulnar diaphysis with posterior angulation at the fracture site and a posterolateral dislocation of the radial head [23]. Bado Type III Monteggia lesions involve a fracture of the ulnar metaphysis with a lateral or anterolateral dislocation of the radial head [23]. Bado Type IV Monteggia lesions involve a fracture of the proximal third of the radius and ulna at the same level with an anterior dislocation of the radial head [23]. Bado included "Monteggia equivalent injuries" based on similarity of proposed injury mechanism, though most do not involve dislocation of the proximal radioulnar joint [23]. The Jupiter classification captures complex Monteggia injury patterns involving radial head/neck fracture and comminution of the proximal ulna with coronoid involvement as a subgroup of Bado posterior Monteggia lesions [98].

Galeazzi: Galeazzi fracture-dislocations are classified into true GFD, where the DRUJ is disrupted, and equivalent GFD [96]. Galeazzi fracture-dislocation types are further subdivided in relation to the radial fracture (incomplete and complete) and ulnar injury (true dislocation versus physeal fracture) [96]. Letts and Rowhani classified Galeazzi fracture-dislocations using the direction of the ulna: volar or dorsal [96]. Acute Galeazzi dislocations are classified as simple when reduction can be easily achieved, and complex characterized by irreducibility or unstable reduction [96].

Clinical Presentation

General Forearm Fractures

The frequency of neurological complications concomitant to forearm fractures is noteworthy [39]. Epidemiological data indicate that the incidence of forearm fractures in both genders has increased when comparing the 1990s with the 1950s [33]. In pediatric populations, children under the age of 15 suffered a total of 360 wrist and forearm fractures during the three winter months; an incidence of 5.9/1000 per year that was only about half that observed during the remainder of the year (10.7/1000 per year) [42]. Atypical forearm fractures are probably more common than reported in the literature to date, and all forearm lesions were accompanied by preceding atypical femur fractures [20].

Isolated Radial Shaft Fractures

Simple, isolated radial shaft fractures are generally very rare injuries, yet they were the most common fractures in a 40-year study of skiers and snowboarders [29]. Forearm fractures were more common in snowboarders than in skiers [29]. Clinicians must recognize that some isolated radial shaft fractures may have been underdiagnosed Galeazzi subluxations [29].

Isolated Ulnar Shaft Fractures

The healing characteristics of isolated ulnar shaft fractures do not appear to differ substantially between surgical and nonsurgical treatment, although nearly 20% of patients treated nonsurgically may require eventual ORIF [43].

Monteggia Fracture-Dislocations

Bado set forth a system of classification based on the mechanism of injury, treatment, and results that established distinction among four types of Monteggia lesions [23]. Bado included a number of so-called Monteggia equivalent injuries based on the similarity of their proposed injury mechanism, further adding to the confusion because most of these injuries do not involve dislocation of the proximal radioulnar joint [23]. The specific types are defined as follows: * Type I: A fracture of the ulnar diaphysis at any level with anterior angulation at the fracture site and an associated anterior dislocation of the radial head [23]. * Type II: A fracture of the ulnar diaphysis with posterior angulation at the fracture site and a posterolateral dislocation of the radial head [23]. * Type III: A fracture of the ulnar metaphysis with a lateral or anterolateral dislocation of the radial head [23]. * Type IV: A fracture of the proximal third of the radius and ulna at the same level with an anterior dislocation of the radial head [23].

Monteggia fractures can be easily overlooked if radiographs of the elbow are not taken, and pre-existing congenital radial head dislocations can lead to inappropriate surgical intervention [52]. The presentation cautions against overlooking radial neck fractures in young children with Monteggia fracture-dislocations, as they may be missed on initial roentgenograms [54]. Problems with the elbow related to fractures of the coronoid process and the radial head remain the most challenging elements in the treatment of these injuries [32]. The clinical outcome remains unpredictable, particularly when there is an associated radial head fracture [25]. The ulnar fracture pattern may be either a simple diaphyseal injury or a more complex metaphyseal injury which has a less favourable prognosis, in part because such injuries also involve an element of fracture dislocation at the elbow joint itself [46]. The localization of the ulna fracture can give a hint for postoperative outcome in Monteggia fractures and Monteggia-like lesions, but increasing instability in fractures located further distally was not confirmed [105]. It is unusual to sustain two Monteggia fractures of the same forearm [5].

Galeazzi Fracture-Dislocations

The Galeazzi fracture is a fracture of the middle to distal third of the radius associated with dislocation and/or instability of the distal radioulnar joint (DRUJ) [37]. Galeazzi fracture-dislocations often go unrecognized and can be mistaken for a simple radius fracture [37]. Dislocation of the distal radioulnar joint should be suspected at the time of injury, with a displaced fracture of the distal shaft of the radius [37]. Persistent instability of the distal radioulnar joint leads to an unfavorable result, with pain at the joint and restriction of forearm rotation [37].

Ability to accurately diagnose true Galeazzi injuries preoperatively based on radiographs alone is limited [83]. Radial shortening was greater, on average, in patients who had clinically significant DRUJ injury as compared to those with isolated radial shaft fractures alone, but this difference was not helpful in diagnosing the injury [83]. Even when increasing the criterion for radial shortening to 10 mm, it was not accurate for diagnosis in individual cases, netting more patients with no DRUJ instability than it did Galeazzi injuries, with less than half having had required intervention to the DRUJ [83]. Three patients with DRUJ instability would have been missed and four patients would have been overdiagnosed when using radial shortening criteria [83]. No significant differences in RoM were found between the injured and uninjured wrist in long-term prognosis of the distal radioulnar joint [13].

Complex and Associated Injuries

Elbow dislocation with ipsilateral radial and ulnar shaft fractures is rare [53]. Considerable force is required to produce elbow dislocation with ipsilateral radial and ulnar shaft fractures and the clinician must have a high suspicion for associated complications [53]. An excellent clinical result was obtained in a case of radial head dislocation with radial shaft fracture by adhering to the basic principles learnt from the management of Monteggia and other proximal forearm fractures [1].

Investigations

Imaging and Diagnostic Principles

Plain radiography: Plain radiographs remain the hallmark and best screening test for elbow evaluation [48]. Monteggia fractures can be easily overlooked if radiographs of the elbow are not taken [52]. Pre-existing congenital radial head dislocations can lead to inappropriate surgical intervention if not recognized on imaging [52]. Radial neck fractures in young children with Monteggia fracture-dislocations may be missed on initial roentgenograms [54]. A high index of suspicion for a possible radial head fracture is required in Monteggia fracture dislocations [55].

CT: CT is helpful when assessing for malunion architecture and the location and pattern of osteophytes and/or loose bodies [82]. 3-dimensional modeling may be a more effective method than standard computed tomography or radiographs for analyzing malunited diaphyseal fractures of both forearm bones [58].

MRI: MRI can be used to evaluate ligaments and tendons, but it is rarely indicated for elbow stiffness evaluation [82].

Other Considerations: Individualized kinematic modeling of forearm malunions reliably detects clinically relevant limitations of forearm rotation without requiring dynamic imaging [51].

Specific Injury Patterns and Classification

Bado classification: The Bado classification distinguishes four types of Monteggia lesions based on the mechanism of injury, treatment, and results [23]. * Type I: Involves a fracture of the ulnar diaphysis at any level with anterior angulation and an associated anterior dislocation of the radial head [23]. * Type II: Involves a fracture of the ulnar diaphysis with posterior angulation and a posterolateral dislocation of the radial head [23]. * Type III: Involves a fracture of the ulnar metaphysis with a lateral or anterolateral dislocation of the radial head [23]. * Type IV: Involves a fracture of the proximal third of the radius and ulna at the same level with an anterior dislocation of the radial head [23].

Associated Injury Patterns: Considerable force is required to produce elbow dislocation with ipsilateral radial and ulnar shaft fractures [53]. The clinician must have a high suspicion for associated complications when elbow dislocation occurs with ipsilateral radial and ulnar shaft fractures [53]. A radial shaft fracture obliquity greater than 30 degrees is predictive of distal radioulnar joint instability [102]. Radial shaft fracture obliquity greater than 30 degrees was the most sensitive radiological parameter (76%) for predicting distal radioulnar joint instability [102]. More distally located radial shaft fractures are significantly associated with higher rates of distal radioulnar joint fixation [121]. Contralateral lateral wrist radiographs are moderate to strongly reliable in determining a distal ulnar diaphyseal angle [125].

Clinical Examination and Assessment

Physical Examination: The physical exam for the elbow is directed by history and the location of the patient's pain in the anterior, posterior, medial, or lateral aspect [48]. Stability of the elbow is conferred by bony articular anatomy and ligamentous structures on the medial and lateral sides [48]. The ulnar nerve is of utmost importance in elbow examination because of its anatomic proximity to the elbow [82]. An assessment for ulnar nerve subluxation should be performed during physical examination [82]. Active and passive flexion, extension, supination, and pronation should be evaluated using a goniometer for accurate measurement [82].

Neurological Assessment: Electromyography/nerve conduction velocity studies should be performed if any question about neurologic dysfunction exists [82].

Treatment

General Principles

The primary goal of treating forearm fractures is to maintain length and radioulnar joint relationships to regain full pronosupination [91]. Anatomic reduction of diaphyseal forearm fractures is emphasized to preserve important anatomic relationships at the proximal and distal radioulnar joints [91].

Non-Operative

Nonoperative management of forearm fractures in adults typically leads to unacceptable outcomes [91]. Even in minimally displaced forearm fractures, deforming forces typically lead to shortening and angulation [91]. For isolated ulnar shaft fractures, an above elbow cast was unnecessarily restrictive for the treatment of isolated ulnar fractures in adults [66]. Instead, isolated ulnar shaft fractures can be treated simply, cheaply and effectively by providing minimal support and early mobilization [103]. However, nonoperative treatment of displaced ulnar nightstick fractures produces a high risk of complications, and the fracture characteristics determine patient outcome [118].

Operative

Indications: Treatment of adult diaphyseal fractures of the forearm with open reduction and plate fixation is considered the standard against which all other treatments are now compared [19]. Compression plate techniques advocated by the AO/ASIF group have become the surgical treatment of choice in simple adult forearm fracture patterns [91]. Bridge plating methods have been used in more complex fracture patterns for forearm fractures [91].

Implant Selection: The results of locking compression plates and dynamic compression plates for the treatment of forearm fractures in adults are similar [26]. Clinical and functional outcomes of LCP plating of diaphyseal forearm fractures are comparable to the use of conventional implants [62]. The forearm remains the only major diaphyseal segment in which intramedullary nailing is seldom employed [91]. The benefits and advantages of medullary fixation are not as apparent in the treatment of forearm fractures as they are in the treatment of femoral fractures [93]. When medullary pins are used in both bones, fixation of the radius must be sufficiently stable to prevent collapse of the radial arch; otherwise, there will be a relative elongation of the radius with distraction of the ulnar fracture, and non-union may result in either or both bones [93]. The technique of using an internal fixator (Point Contact Fixator) is a simple one for the fixation of forearm fractures, resulting in shorter duration of surgery with a low rate of complications compared with conventional techniques [124]. In a prospective multicentric study of the Point Contact Fixator, 355 fractured bones healed uneventfully within four months [124].

Other Considerations: Treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in the reported series) [106]. Timely surgical management with plating and radial head prosthesis of a rare Bado type IV Monteggia-equivalent fracture in adults results in a good prognosis [44]. The goal of treatment for Galeazzi fractures is an anatomic reduction and a rigid internal fixation of the radial fracture [37]. Two years after surgical treatment of a Galeazzi fracture, there is a mean absolute loss of strength of supination of 16.1 kg (12.5%) and pronation of 19.1 kg (27.2%) [47]. Forearm malunions may occur following either non-operative or operative treatment of acute fractures as well as following deformity correction surgery [90]. This article concentrates on the management principles of difficult forearm fractures from penetrating trauma and provides specific examples to illustrate fracture fixation techniques [45].

Complications

Neurological and Soft Tissue

The provided evidence does not specify incidence rates, risk factors, or management protocols for neurological or soft tissue complications in this context.

Bony Healing and Union

Non-union: A substantial percentage of ulnar shaft fractures do not heal successfully with nonsurgical management [15]. In the osteoporotic patient, an isolated fracture of the ulnar shaft is perhaps most safely treated in a long arm cast to prevent stress fracture of the radius following non-union [6].

Joint Instability and Functional Deficit

Monteggia Lesions: The clinical outcome of the posterior Monteggia lesion remains unpredictable, particularly when there is an associated radial head fracture [25]. Monteggia-like lesions with unreconstructible radial head fracture and treatment with radial head replacement are prone to complications and revisions [120].

Bone Atrophy: The long-term fixation of forearm diaphyseal fractures using a locking plate leads to progressive bone atrophy [22].

Recovery

Other Considerations: Long-term functional outcomes following forearm shaft fractures are generally favorable, with specific patterns observed for Galeazzi and Monteggia injuries. In the long-term prognosis of the distal radioulnar joint following Galeazzi fracture–dislocations, no significant differences in range of motion were found between the injured and uninjured wrist [13]. For missed Monteggia fractures, repositioning of the annular ligament resulted in all patients having no pain and full elbow function at the latest follow-up [41].

The provided evidence does not specify standard timelines for light activity, full activity, or complete recovery phases, nor does it detail specific rehabilitation protocols, immobilisation durations, or validated patient-reported outcome measure trajectories. Consequently, these fields are omitted to avoid conflating observation periods with recovery milestones.

Key Evidence

  • [L5] An excellent clinical result was obtained in this unusual injury by adhering to the basic principles learnt from the management of Monteggia and other proximal forearm fractures. [1] (10.1016/0020-1383(95)00077-m)
  • [L3] Surgical intervention in neglected diaphyseal forearm fractures leads to a satisfactory outcome. [2] (10.7759/cureus.31035)
  • [L4] Isolated fractures of the radial diaphysis are more common than true Galeazzi fractures. [3] (10.1016/j.jhsa.2005.09.003)
  • [L5] Optimal outcomes in the treatment of forearm fracture–dislocations depend on early recognition and management, with restoration and maintenance of anatomic alignment being the key principles. [4] (10.1016/j.hcl.2015.01.010)
  • [L5] This case is presented because it is unusual to sustain two Monteggia fractures of the same forearm and the authors could find no such case in a review of the literature. [5] (10.1016/0020-1383(80)90007-8)
  • [L4] We feel that in the osteoporotic patient, an isolated fracture of the ulnar shaft is perhaps most safely treated in a long arm cast. [6] (10.1007/bf00431043)
  • [L4] Closed nailing can be treatment of choice in any forearm shaft fractures. [7] (10.1016/s0020-1383(11)70027-4)
  • [L4] Treatment of adult forearm diaphyseal fracture with the new intramedullary nails have promising results. [8] (10.1016/s0020-1383(13)70138-4)
  • [L4] In isolated ulnar shaft fractures, essentially no immobilization allows rapid healing with a lower rate of loss of forearm motion compared to literature reports. [9] (10.2106/00004623-198365030-00007)
  • [L4] No significant differences in RoM were found between the injured and uninjured wrist. [13] (10.1016/j.hansur.2021.04.012)
  • [L4] Both surgical and nonsurgical management of isolated ulnar shaft fractures are reported as acceptable forms of treatment with high union rates and good functional outcomes. [14] (10.1016/j.hcl.2007.01.004)
  • [L4] Although most ulnar shaft fractures heal successfully with nonsurgical management, a substantial percentage of these fractures do not. [15] (10.1016/j.jhsa.2023.09.009)
  • [Letter] Clinical studies continue to yield contradicting results, and retrospective studies are not able to solve the debate on the optimal treatment of isolated ulnar shaft fractures. [16] (10.1016/j.injury.2015.07.010)
  • [L4] The majority of isolated fractures of the ulnar shaft can be treated adequately by closed means, and the use of short casts is recommended. [18] (10.1016/0020-1383(81)90004-8)
  • [L3] Atypical forearm fractures are probably more common than reported in the literature to date, and all forearm lesions were accompanied by preceding atypical femur fractures. [20] (10.1016/j.injury.2020.10.087)
  • [L4] The long-term fixation of forearm diaphyseal fractures using a locking plate leads to progressive bone atrophy. [22] (10.1016/j.jhsg.2021.05.013)
  • [L5] [23] (10.1016/j.hcl.2007.01.008)
  • [L3] Films obtained within 4 weeks of surgery for radial shaft fractures are unlikely to change postoperative management and may not be warranted during routine postoperative follow-up. [24] (10.1177/1558944715627629)
  • [L4] The clinical outcome remains unpredictable, particularly when there is an associated radial head fracture. [25] (10.1016/0020-1383(95)00187-5)
  • [L4] The results of these two different fixation methods for treatment of fractures of the forearm in adults are similar. [26] (10.1016/s0020-1383(13)70155-4)
  • [L4] Treatment plans for forearm fracture should take into consideration the impact of bone atrophy long after plate fixation. [27] (10.1016/j.jhsa.2017.03.041)
  • [L5] This article reviews the evolution of operative and nonsurgical treatment techniques for forearm diaphyseal fractures from preanesthesia times until today, highlighting the transition from nonsurgical methods with high complication rates to plate osteosynthesis as the surgical treatment of choice after World War II. [28] (10.1016/j.jhsa.2013.06.020)
  • [L3] [29] (10.1097/corr.0000000000001982)
  • [L4] The results of the current study suggest that following open reduction and internal fixation of the radius in patients with Galeazzi fracture-dislocations and with stable DRUJs, immobilization in supination for 4 weeks does not have an advantage over immobilization in neutral for a shorter period. [30] (10.1016/j.jhsa.2011.12.021)
  • [L4] Results of surgical fixation have been good, with only modest losses of forearm strength and rotation. [31] (10.5435/jaaos-22-07-437)
  • [L4] Problems with the elbow related to fractures of the coronoid process and the radial head remain the most challenging elements in the treatment of these injuries. [32] (10.2106/00004623-199812000-00003)
  • [L4] When comparing the 1990s with the 1950s, there is still an increase in the incidence of forearm fractures in both genders. [33] (10.3109/17453679909011249)
  • [L4] Internal fixation by plating is a satisfactory method of treatment for adult forearm fractures, leading to excellent results in a majority of patients. [34] (10.1016/0020-1383(83)90162-6)
  • [L5] Galeazzi injuries are unstable fracture dislocations requiring surgical management to achieve optimal outcomes. [35] (10.1016/j.hcl.2020.07.006)
  • [Paper] [37] (10.1016/j.hcl.2007.03.004)
  • [L4] The frequency of neurological complications concomitant to forearm fractures is noteworthy. [39] (10.1016/j.otsr.2016.04.014)
  • [L5] Utilizing a Delphi process, expert consensus was reached generating a comprehensive list of 26 assessment parameters that can be used to assess surgeon performance in open reduction and internal fixation of an isolated adult ulnar shaft fracture. [40] (10.1016/j.injury.2025.112650)
  • [L4] All patients had no pain and full elbow function at the latest follow-up. [41] (10.1097/bpo.0000000000000584)
  • [L3] Children under the age of 15 suffered a total of 360 wrist and forearm fractures during the three winter months; an incidence of 5.9/1000 per year that was only about half that observed during the remainder of the year (10.7/1000 per year). [42] (10.1016/s0020-1383(02)00212-7)
  • [L4] The healing characteristics of isolated ulnar shaft fractures do not appear to differ substantially between surgical and nonsurgical treatment, although nearly 20% of patients treated nonsurgically may require eventual ORIF. [43] (10.1016/j.jhsa.2022.02.009)
  • [Case_report] Timely surgical management with plating and radial head prosthesis of this rare Bado type IV Monteggia-equivalent fracture in adults results in a good prognosis. [44] (10.5397/cise.2021.00752)
  • [L5] This article concentrates on the management principles of difficult forearm fractures from penetrating trauma and provides specific examples to illustrate fracture fixation techniques. [45] (10.1016/s0749-0712(21)00459-5)
  • [L4] The ulnar fracture pattern may be either a simple diaphyseal injury or a more complex metaphyseal injury which has a less favourable prognosis, in part because such injuries also involve an element of fracture dislocation at the elbow joint itself. [46] (10.1016/s0020-1383(97)88339-8)
  • [L3] Two years after surgical treatment of a Galeazzi fracture, there is a mean absolute loss of strength of supination of 16.1 kg (12.5%) and pronation of 19.1 kg (27.2%). [47] (10.1302/0301-620x.95b11.31524)
  • [L4] Individualized kinematic modeling of forearm malunions reliably detects clinically relevant limitations of forearm rotation without requiring dynamic imaging. [51] (10.1097/corr.0000000000003945)
  • [L4] Monteggia fractures can be easily overlooked if radiographs of the elbow are not taken, and pre-existing congenital radial head dislocations can lead to inappropriate surgical intervention. [52] (10.1016/j.injury.2005.08.028)
  • [L5] [53] (10.1016/s0020-1383(02)00143-2)
  • [L4] This case report illustrates the successful operative treatment of Monteggia fracture dislocation with associated radial head fracture with excellent results and reiterates the importance of holding a high index of suspicion of a possible radial head fracture in Monteggia fracture dislocations. [55] (10.1016/j.injury.2005.05.017)
  • [L4] Malunited diaphyseal fractures of both forearm bones showed complex deformities, which suggests that 3-dimensional modeling may be a more effective method than standard computed tomography or radiographs. [58] (10.1016/j.jhsa.2013.03.052)
  • [L4] The contribution of concavity-compression stability across the radiocapitellar joint to overall elbow stability is clearly demonstrated. [60] (10.1177/1758573216673527)
  • [L4] Clinical and functional outcomes of LCP plating of diaphyseal forearm fractures are comparable to the use of conventional implants. [62] (10.1007/s00402-010-1119-y)
  • [L5] As they suggest in their paper, posterior Monteggia fractures remain a complex management problem with a fine balance between the need to ensure fracture union and the preservation of elbow function and range of movement. [64] (10.1016/s0020-1383(97)87231-2)
  • [L1] An above elbow cast was unnecessarily restrictive. [66] (10.1016/s0020-1383(00)00051-6)
  • [L3] [83] (10.1016/j.injury.2016.04.003)
  • [L4] [90] (10.1007/s11552-014-9635-9)
  • [L4] [91] (10.1016/j.hcl.2010.04.002)
  • [L4] [93] (10.2106/00004623-195739010-00010)
  • [L4] Severe osseous, soft tissue, and neural trauma affect the functional results of the elbow region. [95] (10.1186/1749-799x-1-12)
  • [L4] [96] (10.1055/s-0040-1712515)
  • [L4] [98] (10.1016/j.jhsa.2021.07.023)
  • [L3] A radial shaft fracture obliquity greater than 30 degrees is predictive of distal radioulnar joint instability (P = 0.001) and was the most sensitive radiological parameter (76%) for predicting this instability. [102] (10.1177/1753193418756591)
  • [L2] Isolated ulnar shaft fractures can be treated simply, cheaply and effectively by providing minimal support and early mobilization. [103] (10.1016/0020-1383(91)90043-e)
  • [L3] The localization of the ulna fracture can give a hint for postoperative outcome in Monteggia fractures and Monteggia-like lesions, but increasing instability in fractures located further distally was not confirmed. [105] (10.1186/s13018-022-03195-1)
  • [L4] Treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). [106] (10.1007/s00402-010-1071-x)
  • [L5] Increasing magnitudes of soft tissue disruption result in greater anterior radial head instability. [107] (10.1016/j.jse.2019.10.025)
  • [L5] Biomechanical changes explain the pathological changes in the annular ligament during Monteggia fractures; longitudinal displacement of the radial head causes it to slip out of the annular ligament while the ligament remains intact. [110] (10.1186/s13018-015-0170-3)
  • [L4] Most major traumatic plastic bowing deformities of the ulna involved rotation rather than bending. [112] (10.1016/j.jse.2011.12.006)
  • [L5] Migration of the radius under loads implies disruption of both the central band and triangular fibrocartilage complex. [115] (10.1016/j.jhsg.2023.06.003)
  • [Case_report] The mechanism causing delayed radial head dislocation involved eccentric torque on the radial head during forearm pronation resulting from malunion of the radius. [116] (10.1016/j.jse.2006.05.014)
  • [L3] Nonoperative treatment of displaced fractures produces a high risk of complications, and the fracture characteristics determine patient outcome. [118] (10.1016/j.injury.2015.02.012)
  • [L4] Monteggia-like lesions with unreconstructible radial head fracture and treatment with radial head replacement are prone to complications and revisions. [120] (10.1186/s13018-019-1540-z)
  • [L3] More distally located radial shaft fractures are significantly associated with higher rates of DRUJ fixation. [121] (10.1177/15589447211006836)
  • [L4] The direction of radial head dislocation (anterolateral or posterolateral) may depend on the rotational position of the forearm at the time of the primary adduction injury. [123] (10.2106/00004623-197759040-00024)
  • [L2] This study demonstrated that the technique of using an internal fixator is a simple one for the fixation of forearm fractures, resulting in shorter duration of surgery with a low rate of complications compared with the data reported in the literature on conventional techniques for forearm fracture stabilization. 355 fractured bones healed uneventfully within four months. [124] (10.1016/s0020-1383(01)00126-7)
  • [L4] Contralateral lateral wrist radiographs are moderate to strongly reliable in determining a DUDA. [125] (10.1016/j.jhsa.2021.08.003)
  • [L4] Anatomic reduction of the ulna is critical to achieving a favorable outcome, as it indirectly reduces the radiocapitellar joint. [126] (10.5435/jaaos-d-19-00625)
  • [L4] Correction of the ulnar deformity with elongation and angulation of the ulna in the opposite direction of the dislocation of the radial head is the most important factor for the reduction and consequent preservation of the radial head. [127] (10.1097/mop.0000000000000710)
  • [Case_report] Inaccurate contouring of a compression plate can reverse the normal sagittal bow of the radius, generating deforming forces that lead to anterior dislocation of the distal end of the ulna. [128] (10.2106/00004623-199304000-00014)
  • [L5] In cases with significant soft tissue injury, the elbow should be immobilized in a flexed and supinated position to allow relaxation of the biceps and avoid movement of the elbow in the early postoperative period. [129] (10.1016/j.jht.2020.03.012)

See Also

References

[1] Radial head dislocation with radial shaft fracture. Injury. 1995. DOI: 10.1016/0020-1383(95)00077-m

[2] Functional Outcomes of Neglected Forearm Diaphyseal Fractures Treated Surgically: A Prospective Cohort Study. Cureus. 2022. DOI: 10.7759/cureus.31035

[3] Isolated Radial Shaft Fractures Are More Common Than Galeazzi Fractures. The Journal of Hand Surgery. 2006. DOI: 10.1016/j.jhsa.2005.09.003

[4] Management of Complications of Forearm Fractures. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.01.010

[5] Repeat Monteggia fracture: an unusual occurrence. Injury. 1980. DOI: 10.1016/0020-1383(80)90007-8

[6] Stress fracture of the radius following non-union of an isolated fracture of the ulna. Archives of Orthopaedic and Trauma Surgery. 1992. DOI: 10.1007/bf00431043

[7] A10 Fixator assisted nailing in radial and ulnar shaft fractures. Injury. 2011. DOI: 10.1016/s0020-1383(11)70027-4

[8] PF5 Clinical results of new intramedullary nails for the treatment of forearm diaphyseal fractures. Injury. 2013. DOI: 10.1016/s0020-1383(13)70138-4

[9] The isolated fracture of the ulnar shaft. Treatment without immobilization.. The Journal of Bone & Joint Surgery. 1983. DOI: 10.2106/00004623-198365030-00007

[10] Forearm fractures: treatment by rigid fixation with early motion.. The Journal of Bone and Joint Surgery. American Volume. 1980.

[13] Galeazzi fracture–dislocations: Long-term prognosis of the distal radioulnar joint. Hand Surgery and Rehabilitation. 2021. DOI: 10.1016/j.hansur.2021.04.012

[14] Management of Isolated Ulnar Shaft Fractures. Hand Clinics. 2007. DOI: 10.1016/j.hcl.2007.01.004

[15] Risk Factors for Failure of Nonsurgical Management of Ulnar Shaft Fractures. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2023.09.009

[16] Response to: “Coulibaly M, et al. Results of 70 consecutive ulnar nightstick fractures” [Injury 2015]. Injury. 2015. DOI: 10.1016/j.injury.2015.07.010

[17] Diaphyseal Fractures of the Radius and Ulna. 2019.

[18] The treatment of isolated fractures of the ulnar shaft in adults. Injury. 1981. DOI: 10.1016/0020-1383(81)90004-8

[19] Chapter 94 Forearm Trauma and Diaphyseal Fractures. 2019.

[20] Risk factors for atypical forearm fractures associated with bisphosphonate usage. Injury. 2021. DOI: 10.1016/j.injury.2020.10.087

[22] Long-term Evaluation Using Finite Element Analysis of Bone Atrophy Changes after Locking Plate Fixation of Forearm Diaphyseal Fracture. Journal of Hand Surgery Global Online. 2021. DOI: 10.1016/j.jhsg.2021.05.013

[23] Monteggia Fracture-Dislocations. Hand Clinics. 2007. DOI: 10.1016/j.hcl.2007.01.008

[24] Utility of Postoperative Imaging in Radial Shaft Fractures. HAND. 2016. DOI: 10.1177/1558944715627629

[25] The posterior Monteggia: a pathological lesion?. Injury. 1996. DOI: 10.1016/0020-1383(95)00187-5

[26] PS6 Comparison of locking compression plates and dynamic compression plates in the management of forearm fractures in adults. Injury. 2013. DOI: 10.1016/s0020-1383(13)70155-4

[27] Evaluation of Bone Atrophy After Treatment of Forearm Fracture Using Nonlinear Finite Element Analysis: A Comparative Study of Locking Plates and Conventional Plates. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.03.041

[28] History of Operative Treatment of Forearm Diaphyseal Fractures. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.06.020

[29] A 40-year Study of the Factors Associated with Diaphyseal Forearm Fractures in Skiers and Snowboarders. Clinical Orthopaedics & Related Research. 2021. DOI: 10.1097/corr.0000000000001982

[30] Immobilization in Supination Versus Neutral Following Surgical Treatment of Galeazzi Fracture-Dislocations in Adults: Case Series. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.12.021

[31] Management of Adult Diaphyseal Both-bone Forearm Fractures. Journal of the American Academy of Orthopaedic Surgeons. 2014. DOI: 10.5435/jaaos-22-07-437

[32] Monteggia Fractures in Adults. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199812000-00003

[33] Forearm fractures in Malmo, Sweden: Changes in the incidence occurring during the 1950s, 1980s and 1990s. Acta Orthopaedica Scandinavica. 1999. DOI: 10.3109/17453679909011249

[34] Results of AO plate fixation of forearm shaft fractures in adults. Injury. 1983. DOI: 10.1016/0020-1383(83)90162-6

[35] Galeazzi Injuries. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.07.006

[37] Galeazzi Fractures and Dislocations. Hand Clinics. 2007. DOI: 10.1016/j.hcl.2007.03.004

[39] Pre- and postoperative complications of adult forearm fractures treated with plate fixation. Orthopaedics & Traumatology: Surgery & Research. 2016. DOI: 10.1016/j.otsr.2016.04.014

[40] Development of an assessment tool for open reduction and internal fixation of midshaft ulnar fractures: A global delphi consensus study. Injury. 2025. DOI: 10.1016/j.injury.2025.112650

[41] Repositioning of the Annular Ligament in the Management of Missed Monteggia Fracture. Journal of Pediatric Orthopaedics. 2017. DOI: 10.1097/bpo.0000000000000584

[42] Seasonal variation in the incidence of wrist and forearm fractures, and its consequences. Injury. 2003. DOI: 10.1016/s0020-1383(02)00212-7

[43] Does Surgery Improve Healing After Isolated Diaphyseal Ulna Fractures?. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.02.009

[44] Type IV Monteggia-equivalent fracture in an adult: a case report. Clinics in Shoulder and Elbow. 2023. DOI: 10.5397/cise.2021.00752

[45] THE TREATMENT OF FOREARM FRACTURES FROM PENETRATING TRAUMA. Hand Clinics. 1999. DOI: 10.1016/s0749-0712(21)00459-5

[46] The adult anterior monteggia fracture dislocation: long-term results of plate fixation. Injury. 1997. DOI: 10.1016/s0020-1383(97)88339-8

[47] The effect of a Galeazzi fracture on the strength of pronation and supination two years after surgical treatment. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b11.31524

[48] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Summary and Conclusions.

[50] Rockwood And Green S Fractures In Adults. 41: Diaphyseal Fractures of the Radius and Ulna > Classification of Diaphyseal Fractures of the Radius and Ulna.

[51] Can Personalized 3D Kinematic Modeling Predict Loss of Pronation and Supination in Diaphyseal Forearm Malunions? A Clinical Validation Study. Clinical Orthopaedics & Related Research. 2026. DOI: 10.1097/corr.0000000000003945

[52] When is a Monteggia fracture not a Monteggia fracture?. Injury Extra. 2007. DOI: 10.1016/j.injury.2005.08.028

[53] Elbow dislocation with ipsilateral open radial and ulnar diaphyseal fractures — a rare combination. Injury. 2004. DOI: 10.1016/s0020-1383(02)00143-2

[54] Monteggia Fracture: PRESENTATION OF AN UNUSUAL CASE.. The Journal of Bone and Joint Surgery. American Volume. 1974.

[55] Monteggia fracture dislocation with radial head fracture: The need for early recognition and review of the literature. Injury Extra. 2005. DOI: 10.1016/j.injury.2005.05.017

[58] 3-Dimensional Deformity Analysis of Malunited Forearm Diaphyseal Fractures. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.03.052

[60] Ulnohumeral dislocation despite intact radiocapitellar joint: a rare Monteggia variant. Shoulder & Elbow. 2016. DOI: 10.1177/1758573216673527

[62] Problems of bridging plate fixation for the treatment of forearm shaft fractures with the locking compression plate. Archives of Orthopaedic and Trauma Surgery. 2010. DOI: 10.1007/s00402-010-1119-y

[64] The posterior Monteggia: a pathological lesion?. Injury. 1996. DOI: 10.1016/s0020-1383(97)87231-2

[66] The treatment of isolated ulnar fractures in adults: a systematic review. Injury. 2000. DOI: 10.1016/s0020-1383(00)00051-6

[68] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Biomechanics, Physical Examination, and Imaging of the Elbow > Anatomy > Bony Anatomy.

[69] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > TABLE 2.3 Shoulder Spaces.

[70] Miller S Review Of Orthopaedics. Genetics of musculoskeletal conditions and abnormalities are summarized in Table 1.27 > TABLE 2.3 Shoulder Spaces.

[74] Miller S Review Of Orthopaedics. ELBOW.

[75] Miller S Review Of Orthopaedics. SECTION 16 PATELLAR TRACKING IN TOTAL KNEE ARTHROPLASTY > ELBOW.

[76] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > INJURIES AROUND THE ELBOW.

[79] Rockwood And Green S Fractures In Adults. 29: Principles of Nonunion and Bone Defect Treatment > Pathoanatomy and Applied Anatomy Related to Distal Humerus Fractures.

[82] Aaos Comprehensive Orthopaedic Review 3. Elbow Stiffness* > IV. Evaluation.

[83] Galeazzi fractures: Is DRUJ instability predicted by current guidelines?. Injury. 2016. DOI: 10.1016/j.injury.2016.04.003

[90] Reconstruction of Malunited Diaphyseal Fractures of the Forearm. HAND. 2014. DOI: 10.1007/s11552-014-9635-9

[91] Intramedullary Fixation of Forearm Fractures. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.04.002

[93] Medullary Fixation of Forearm Fractures. The Journal of Bone & Joint Surgery. 1957. DOI: 10.2106/00004623-195739010-00010

[95] Unusual patterns of Monteggia fracture-dislocation. Journal of Orthopaedic Surgery and Research. 2006. DOI: 10.1186/1749-799x-1-12

[96] Open Galeazzi's Fracture-Dislocation in a 13-Year-Old Boy: A Case Report. Journal of Wrist Surgery. 2020. DOI: 10.1055/s-0040-1712515

[98] Surgical Management of Complex Adult Monteggia Fractures. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.07.023

[102] Radial shaft fracture obliquity as a predictor of distal radioulnar joint instability. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418756591

[103] Isolated fractures of the ulnar shaft. Injury. 1991. DOI: 10.1016/0020-1383(91)90043-e

[105] Monteggia fractures: analysis of patient-reported outcome measurements in correlation with ulnar fracture localization. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03195-1

[106] Treatment of diaphyseal non-unions of the ulna and radius. Archives of Orthopaedic and Trauma Surgery. 2010. DOI: 10.1007/s00402-010-1071-x

[107] Effect of ulnar angulation and soft tissue sectioning on radial head stability in anterior Monteggia injuries: an in vitro biomechanical study. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.10.025

[110] Biomechanical analysis of the annular ligament in Monteggia fractures using finite element models. Journal of Orthopaedic Surgery and Research. 2015. DOI: 10.1186/s13018-015-0170-3

[112] Three-dimensional analysis of acute plastic bowing deformity of ulna in radial head dislocation or radial shaft fracture using a computerized simulation system. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.12.006

[115] Anatomic and Biomechanical Study of the Forearm Interosseous Membrane, Distal Oblique Bundle, and Triangular Fibrocartilage Complex: Role in Galeazzi Fracture Dislocation. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.06.003

[116] Delayed radial head dislocation associated with malunion of radial shaft fracture: A case report. Journal of Shoulder and Elbow Surgery. 2007. DOI: 10.1016/j.jse.2006.05.014

[118] Results of 70 consecutive ulnar nightstick fractures. Injury. 2015. DOI: 10.1016/j.injury.2015.02.012

[120] Monteggia-like lesions in adults treated with radial head arthroplasty—mid-term follow-up of 27 cases. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-019-1540-z

[121] Higher-Than-Expected Rates of Distal Radioulnar Joint Fixation in Radial Shaft Fractures: Location of Fracture Matters. HAND. 2021. DOI: 10.1177/15589447211006836

[123] The lateral Monteggia fracture. The Journal of Bone & Joint Surgery. 1977. DOI: 10.2106/00004623-197759040-00024

[124] Treatment of diaphyseal fractures of the forearm using the Point Contact Fixator (PC-Fix): Results of 387 fractures of a prospective multicentric study (PC-Fix II). Injury. 2001. DOI: 10.1016/s0020-1383(01)00126-7

[125] Radiographic Determination of the Distal Ulnar Diaphyseal Angle. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.08.003

[126] Complex Monteggia Fractures in the Adult Cohort: Injury and Management. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-19-00625

[127] Chronic Monteggia. Current Opinion in Pediatrics. 2019. DOI: 10.1097/mop.0000000000000710

[128] Anterior dislocation of the distal end of the ulna after use of a compression plate for the treatment of a Galeazzi fracture. A case report.. The Journal of Bone & Joint Surgery. 1993. DOI: 10.2106/00004623-199304000-00014

[129] The role of biceps loading and muscle activation on radial head stability in anterior Monteggia injuries: An in vitro biomechanical study. Journal of Hand Therapy. 2021. DOI: 10.1016/j.jht.2020.03.012

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4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.