Diagnosis of Monteggia fractures require a true lateral view of the elbow, with attention to the radiocapitellar line If a line drawn through the long axis of the radius fails to pass through the center of the capitellum on all projections a radial head dislocation should be considered ( Fig 111.16 ) It is worth noting that even bowing fractures of the ulna have been associated with radial head dislocation Recognition of these injuries with immediate orthopedic consultation is crucial to prevent long-term disability In pediatric patients, timely closed reduction of the fracture and dislocation followed by long arm splinting will minimize risk of permanent disability secondary to chronic irreducible radial head dislocation, limited supination and pronation, as well as nerve injury Galeazzi fractures often require operative intervention, and the complications are few with proper management FIGURE 111.28 Upper extremity motor nerve physical examination A: Rock position demonstrates median nerve motor function B: Paper position demonstrates radial nerve motor function C: Scissor position demonstrates ulnar nerve motor function D: “OK” sign demonstrates function of the anterior interosseous nerve (Reprinted with permission from Waters PM, Skaggs DL, Flynn JM Rockwood and Wilkins’ Fractures in Children 9th ed Philadelphia, PA: Wolters Kluwer; 2020.)