This study is a retrospective review of 22 patients treated with open reduction of the radial head for post-traumatic chronic radial head dislocations. The mean age at the time of surgery was 10 years and 2 months (range, 4-20 years). Five patients had a radial nerve palsy and neurolysis was performed at the time of the reconstruction. The mean interval between the initial injury and the reconstruction was 10 months (range, 2 months – 5 years and 2 months). The type of surgery chosen was based on the preference of the surgeon. Prior to 1991, this was quite variable, including open reduction of the dislocated radial head followed by a radial and/or ulna osteotomy (with or without reconstruction of the annular ligament) or by reconstruction of the ligament alone. After 1991, an oblique flexion and lengthening proximal metapyseal osteotomy of the ulna was performed with rigid plate fixation and bone grafting when necessary. The ulna osteotomy was performed in order to allow for reduction of the radial head and minimization of pressure on the radiocapitelar joint. The annular ligament reconstruction was performed with a portion of triceps fascia. Post operatively, a cast was applied with the elbow in 90 degrees of flexion and neutral forearm rotation for two weeks followed by active forearm rotation. Four of 13 patients treated before 1991 were successfully reduced where as 7 of 9 treated since 1991 were successfully reduced. The elbow redislocated in 7 patients treated before 1991 and in no patients treated since 1991. The two radial head subluxations noted since 1991 were in patients with moderate radial head deformity but only one patient complained of pain and disturbance of daily activities at most recent follow-up. Seven patients treated before 1991 and two since 1991 had restricted forearm rotation . Mean flexion-extension arc of motion was approximately 130 degrees. There was slight degenerative changes in two elbows despite one elbow with a good reduction and the other being subluxated. Five of the 7 redislocated elbows had substantial radial head deformity.
Presumably these 22 patients, all below the age of 20, originally had a Monteggia fracture-dislocation. Although not commented by the authors, residual ulna malalignment is more likely in the older age group because of the diminished remodeling potential. These authors recommend ulna flexion and lengthening osteotomy in order to reduce the overgrown radial head and minimize pressure on the radiocapiteler joint. The ulna osteotomy allowed for improved overall long-term relocation rates. Ligament reconstruction alone, however, may be adequate in the younger patient with a chronic radial head dislocation without significant radial head overgrowth or malalignment of the ulna. It does appear that the major contraindication to this procedure is significant dysplasia of the radial head, which was associated with a higher incidence of subluxation or redislocation.
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