Ten cases of missed Monteggia lesions were reviewed following treatment. Four cases were treated with an ulnar osteotomy, open reduction of radial head and annular ligament reconstruction (Group A). In six cases only an open reduction of the radial head was performed with an ulnar osteotomy (Group B). No annular ligament reconstruction was done in Group B. The mean age seven in both groups (range 4-12 years). The children presented three months to 24 months after the initial injury. Nine patients were classified as Bado type I, and one with Bado type III injury. The mean follow-up was 20 months (8-26 months) after surgery. In both groups the ulnar osteotomy healed uneventfully. In group A, there was one superficial infection, the mean loss of pronation was 12 degrees and in one case the radial head re-subluxed. In group B, the mean loss of pronation was 10 degrees. Elbow flexion was comparable to Group A. No radial head subluxation was seen in this group. No child in either group had any functional limitation in activities. Thus, in chronic Monteggia lesion, annular ligament reconstruction is not always required to restore radio-capitellar alignment. Open reduction of radial head with an ulnar osteotomy and stable fixation will suffice. Ligament reconstruction will not stabilise an inadequately reduced radial head