Monteggia fractures comprise a small subset of fractures in the pediatric population that are normally reduced nonoperatively. Complex Monteggia fractures can be more difficult to identify and require operative intervention. We describe a case of a Bado type I Monteggia fracture with a posteriorly dislocated radial head and neck fracture that has not been described before in the literature. The patient required advanced imaging because of ossification delays and led to an operative intervention to reduce the radial head and neck. This case exemplifies how irreducible Monteggia fractures may necessitate advanced imaging to determine blocks to a successful reduction.