Monteggia fractures are rare injuries. Early recognition is crucial in order to achieve good functional results. In the presented review paper it is pointed out that any fracture or angulation of the ulna should thoroughly be checked for any incomplete or complete dislocation of the radial head. Adequate clinical examination and radiologic evaluation are mandatory. The aim of treatment must be repositioning and retention of the radial head and restoration of the ulnar alignment. During the last years, surgical treatment has become more important for achieving good functional results and foar avoiding secondary corrective surgery. For the majority of acute Monteggia lesions, immediate repositioning maneuvers with surgical stabilization of the ulna (elastic nailing techniques) under general anesthesia are indicated. Cast immobilization is of short duration; physical therapy is normally not necessary. Treatment of missed Monteggia lesions or chronic radial head dislocations is more difficult. Nevertheless, newer surgical techniques for secondary operative correction of ulnar malalignment are promising.