CHRONIC RADIAL HEAD DISLOCATION IN CHILDREN. TREATMENT BY OPEN REDUCTION AND ULNAR OSTEOTOMY

Abstract

Purpose: To present the results of open reduction andangulating-distraction ulnar osteotomy in children with chronic radialhead dislocation.Material and Methods: This is a retrospective review of 4 children (3girls, one boy) with chronic radial head dislocation treated in ourhospital between 2009 and 2012. The average age at the time of surgerywas 6.6 (4.2 - 9.1 years). The interval between initial trauma andsurgery was from 2 to 25 months. Three of the patients had a plasticdeformation of the ulna with a positive ``ulnar bow sign{''} and one waswith missed radial head dislocation after an equivalent injury.The surgical strategy in all patients included proximal ulnar osteotomywith angulation and distraction and open reduction of the dislocatedradial head without annular ligament reconstruction or pinning.Osteotomy was fixed with a prebent one-third tubular plate and atricortical bone graft.Results: The mean follow-up was 4 years (range 2.5 - 5.5). Radial headremained reduced and stable in all cases. All ulnar osteotomies healedwithout any complications. The postoperative range of motion wasimproved in all of the patients. Functional outcomes assessed by ElbowPerformance Score were excellent in three and good in one of thepatients.Conclusions: The treatment of an unrecognized radial head dislocation inchildren continues to pose a therapeutic challenge. The osteotomy of theproximal ulna with both angulation and elongation allows stable radialhead reduction without necessity of annular ligament reconstruction inmost of the cases.