Hetthéssy JR, et al. - Researchers sought to delineate their three-step approach to the treatment of acute Monteggia lesions based on the stability and radiological appearance of the fracture-dislocation. Further, they provided an overview of possible pitfalls and clinical and radiological signs that support the diagnostic process. Twenty-three patients who underwent treatment for this type of injury were retrospectively analyzed. The following treatment modalities were reported: 1. closed reduction under image intensifier followed by immobilization in over the elbow cast, 2. open reduction and intramedullary nailing with ESIN, or 3. open reduction and plate osteosynthesis. Follow-up was performed for an average period of 37 months. The selected procedure in the 23 acute cases –reduction+casting/reduction+ESIN/reduction+plating – was performed within 2 to 16 hours of arrival. Treatment with reduction+casting was performed in 10 patients, with reduction+ESIN in 10 patients and with reduction+plating in 3. For long-term follow-up, 21 patients were available. In all but one of the acute cases, successful management was achieved with the Three Step Method retaining the reduction. All three groups exhibited excellent range of motion. Findings thereby support that in these lesions, the Three Step Method allows primary definitive treatment with low complication rates and a good range of motion results.