Accurate diagnosis is essential because management is surgical by open reduction and internal fixation.  The deforming muscular and soft tissue injuries cannot be controlled with cast immobilization.  In fact, Campbell termed this the “fracture of necessity” in 1942 since nonsurgical management led to recurrent distal ulna dislocations.  Accordingly, in 1957 Hughston described an unsatisfactory result in 35 of 38 patients treated with closed reduction and casting.