Kawoosa et al. Journal of Medical Case Reports 2010, 4:344 http://www.jmedicalcasereports.com/content/4/1/344 Page 4 of 6 Figure 6 Postoperative radiograph during disraction lengthening (Patient 2). Discussion Owing to the potential complications of conservative methods in cases of neglected Monteggia injuries, it is important that the radial head be replaced in appropri- ate relation to the capitellum. This is especially true in children who are less than 12 years of age. In procedures involving reconstruction around the radial head, it is mandatory to stabilize the radial head by a transcapitellar K wire to prevent redislocation [4,7]. In one study, Hori et al. reported that of the 13 patients treated surgically with open reduction, ulnar osteotomy and annular ligament reconstruction, there were seven re-dislocations, and seven patients had restriction of movement [15]. The authors reported that they achieved better results once they modified the osteotomy proce- dure, and stressed the need for angulation and elonga- tion of the osteotomy. Rodgers et al. reported 14 complications in seven patients, including problems with the osteotomy site, re-dislocations and nerve inju- ries [12]. Figure 7 Radiograph taken at the two-year follow-up visit showng excellent relocation of the radial head (Patient 1). Restriction of movement has been seen frequently in procedures involving radial head reconstruction [10,11]. Problems with the fixation of the osteotomy are not uncommon [13]. Hasler found it easy to reconstruct the radiocapitellar joint, and to allow early resumption of functional exercises by using external fixation for the ulnar osteotomy with no annular ligament reconstruc- tion [16]. Freedman et al. used a technique in which the annular ligament was not reconstructed but the radial notch was deepened to achieve stability [6]. Chronic dislocations may be associated with signifi- cant discrepancy in the radioulnar length, the radius having overgrown as a result of lack of support between the capitellum and the radial head. The optimum treat- ment in these patients is lengthening of the osteotomy in addition to angulation. The excellent results of a lengthening osteotomy are best reflected in the cases presented by Exner, who used distraction lengthening over a uniplanar lengthening device to create hyperan- gulation and lengthening to reduce the radial head [14]. However, the process of hyperangulation was performed after distraction at subsequent stages under analgesia. We found the Ilizarov technique to be advantageous in other respects as well, as it allows lengthening and angulation in several planes, and the processes of lengthening and angulation proceed simultaneously.