If fracture is unstable intramedullary fixation of the ulna with a K-wire or a Rush rod inserted percutaneously in the younger child. Older children may require plating . If the radial head will not reduce, there may be interposition of the annular ligament or osteocartilaginous fragments. Using a posterior approach to the elbow, both components of the monteggia lesion can be approached. If the annular ligament cannot be repaired it can be reconstructed using triceps fascia .
Many authors condemn transcapitellar pinning of the radial head.
Cross pinning of the radius to the ulna increases risk of a cross-union. Leaving the radial head dislocated will result in progressive valgus deformity and collateral ligament instability of the elbow with restricted motion. May also be due to interposition of the annular ligament or the radial nerve. Persistent dislocation of the radial head and healed angular deformity of the ulna. May need to osteotomize the ulna and reconstruct the annular ligament.