Chronic Radial Head Dislocation in Children Part II

Author(s): Kim HT, Byung GP, Suh JT, Yoo CI

Source: J Pediatr Orthop 22: 591-597, 2002

Summary:

This report deals with the outcome of chronic radial head dislocation using a consistent surgical approach.  Two of fourteen children comprised the study cohort.  Fifteen total cases were performed for either congenital or posttraumatic dislocation.  Follow-up averaged 43.5 months and consisted of radiographs and clinical parameters.  A grading scale was also devised to assess parameters including deformity, pain, range of motion and function. X-rays at follow-up showed that thirteen of the fifteen cases remain reduced.  Two cases of congenital dislocations were not concentrically aligned.  Traumatic cases demonstrated enhanced motion that was improved at follow-up in the flexion-extension arc, with  supination arcs of 19% and 11.8% respectively.  Loss of pronation of approximately 9% was found in ten patients.  Heterotopic ossification was observed in two patients and one patient developed a radioulnar synostosis. The surgical correction consisted of a uniform approach.  Initially, an open reduction, debridement of soft tissues, and annular ligament reconstruction was performed using a strip of the triceps tendon.  Stable reduction was obtained in only two patients.  The second part of the procedure consisted of radial shortening, rotational osteotomy, and radial head arthroplasty.  This was indicated in cases of irreducible radial heads.  Rotational adjustment was made in the radial head orientation in three cases because of angular deformity.  In the presence of bowing of the ulna, an ulnar osteotomy was performed to offer correction of the overall ulnar alignment.  Lastly, excision of osteophytes or hypertrophic bone was necessary to allow for the radial head to reduce into its original anatomic site. 

Surgical reconstruction of a chronic radial head dislocation in a pediatric patient is a considerable undertaking.  This uniform surgical approach provided excellent results in ten cases.  Two patients had good results, two had fair results and one had a poor result.  Although the amount of dysplastic changes increases over time, the results from surgical correction could not be correlated with time from dislocation.  Although slight loss of pronation was a common sequella, maintenance of radial head reduction, coupled with adequate supination, warrant surgical consideration for the symptomatic individual.  


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