The true instance of dislocation of the radial head in children with cerebral palsy is unknown. The dislocation may or may not be symptomatic. This study was performed to report the author’s surgical experience with the treatment of symptomatic radial head dislocation in children with cerebral palsy. Eight patients with severe spastic quadriplegia underwent treatment for symptomatic radial head dislocations. The direction of dislocation was anterolateral in two elbows, posterior in six elbows, and posterolateral in two elbows. The average age was 10 years. Pain was present in all patients, as was limitation of motion. Four patients underwent open reduction of the radial head dislocation and release of associated contractures. Frequently, the biceps and brachialis muscles were lengthened or released. Four additional patients underwent excision of the radial head and associated contracture release, followed by early range of motion. Follow-up of the patients who had open reduction revealed that all four patients complained of pain with elbow motion, and re-dislocation was noted in every patient. In contrast, all four patients who underwent radial head excision remained pain-free, with increased elbow motion.
This study highlights several factors. The incidence of radial head dislocation is unknown in children with cerebral palsy. Most children remain asymptomatic and do not warrant management. The pathophysiology of dislocation in children with cerebral palsy has not been confirmed, but most likely represents a muscular imbalance about the elbow. In the cases of symptomatic radial head dislocation, simple excision and early range of motion is more efficacious than attempts at relocation of the radial head. Attempts at relocation and stabilization of the dislocation by open reduction, and ligament reconstruction, and release of associated contractures were uniformly unsuccessful and should be avoided.
J Ped Orthop