Objective: To explore the application value of arthrography in the diagnosis and treatment of fresh Monteggia fractures in children. Methods: A total of 46 children with fresh Monteggia fractures were enrolled in this study, all underwent elbow arthrography, 3 underwent manual plaster fixation, 15 underwent elastic intramedullary nail fixation, 8 underwent plate screw fixation, 7 Kirschner-wire tension-band fixation, 8 mini-Ilizarov external fixation, 5 unilateral external fixation. All patients were fixed in plaster for 4-6 weeks with elbow flexion and forearm supination position, and functional exercise was performed after the plaster was removed. Results: All patients had surgical procedures performed smoothly without serious complications. All 46 children were followed up for 6-24 months;The range of motion in elbow flexion- extension and the range of motion in forearm rotation recoverd well at the latest follow up.according to Mayo Elbow joint scoring criteria, the excellent and good rate was 100%；according to postoperative imaging , the excellent and good rate of fracture reduction was 100%. Conclusion: According to the type of ulna fracture, different treatment options are selected. The application of elbow arthrography can clearly show the shape of the elbow joint, accurately reflect the reduction effect, and further make good treatment effect. Key words：Monteggia fractures；children；arthrography；elbow.