Reconstruction of late or chronic Monteggia fracture-dislocation. A, Clinical deformity of chronic Monteggia lesion with increased cubitus valgus. B, Extensile incision for annular ligament reconstruction and ulnar osteotomy. C, Exposure of radiocapitellar and radioulnar joint with elevation of extensor-supinator origin from lateral epicondyle, protection of radial nerve, and thorough joint debridement. D, Radial head with osteochondral change from chronic dislocation. Annular ligament has been reduced around radial neck, and sutures are in place for reconstruction to annular ligament. E, Ulnar opening wedge osteotomy at site of maximal deformity. (Redrawn from Shah AS, Waters PM: Monteggia fracture-dislocations in children. In Flynn JM, Skaggs DL, Waters PM, editors: Rockwood and Wilkins’ fractures in children, ed 8, Philadelphia, 2015, Wolters Kluwer.) SEE TECHNIQUE 36.14.