We present a case of a type I Monteggia equivalent lesion in a 7-year-old child consisting of anterior dislocation of the radial head, radial neck fracture, and a fracture of the olecranon without an associated fracture of the ulnar diaphysis or metaphysis. After a review of the literature, we report this fracture pattern as a rare type I Monteggia equivalent fracture-dislocation variant. This report describes delayed surgical treatment and outcome after close follow-up of a rare type I Monteggia equivalent lesion. Diagnostic challenges with and treatment options for pediatric Monteggia equivalent fracture-dislocations are discussed.