Our experience with pediatric treatment of chronic radial head dislocation

Objective Improve the effectiveness of pediatric treatment of chronic radial head dislocations (CRHD). Material and methods The review included 100 pediatric patients aged 2–18 years treated for CRHD between 2005 and 2019. Patients underwent physical examination, radiological (conventional radiography, US, MRI, MSCT) evaluation and statistical analysis was performed. Patients were divided into two groups. A major group consisted of 33 (33%) patients who were treated with new bone and plasty procedures including open reduction of the radial head (ORRH), plasty of the annular ligament with m. anconeus flap and fixation with the plaster cast; osteotomy of the proximal ulna and ulnar realignment with the Ilizarov external fixation. Outcomes were retrospectively compared with 67 (67.0 %) control patients treated with different classical techniques including ORRH, radial head fixation with wires, polyethyleneterephthalate band or the remnants of the annular ligament, with/without ulnar osteotomy. Anatomical and functional results of treatment were evaluated at a short (up to one year) and long term (over one year) after frame removal using modified Mattis-Lyuboshitz-Shwarzberg grading scale. Results Comparative analysis of outcomes of surgical management at a short- and long term in both groups showed that the percentage of good results was 1.5 times higher in the major group. A table of differentiated indications to pediatric treatment of CRHD was devised based on the findings. Conclusion Biomechanical articular parameters appear to deteriorate over time following radial head dislocation and can result in radial head deformity, malaligned and shortened ulna. Pediatric treatment is supposed to be differentiated depending on time of injury, patient's age, anatomical and radiological manifestations of the joint. Operative pediatric treatment of CRHD involving bone and plasty procedures can provide good internal fixation preventing recurrence.

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Type IV Monteggia fracture in a cat

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-11-01-0005 ◽

2011 ◽

Vol 24 (06) ◽

pp. 483-486 ◽

Cited By ~ 2

Author(s):

T. Lopez ◽

A. Autefage ◽

I. Irubetagoyena

Keyword(s):

Radial Head ◽

Plate Fixation ◽

Fracture Reduction ◽

Annular Ligament ◽

Monteggia Fracture ◽

Radial Head Dislocation ◽

Ulna Fracture ◽

Type Iv ◽

One Year

SummaryA one-year-old neutered male cat was referred for a grade IIIA open radius and ulna fracture. The mid-diaphyseal radial and ulnar fractures were associated with lateral radio-humeral and radio-ulnar dislocations. From these abnormalities, a diagnosis of type IV Monteggia fracture was made. The annular ligament was found to be intact on examination and the radial head was correctly positioned and stable after fracture reduction and plate fixation. Eighteen months postoperatively, the cat did not exhibit any signs of lameness or any signs of pain on palpation and mobilisation. Signs of mild osteoarthritis were present on radiographs.Type IV Monteggia fractures are very rare in animals. The combination of a radial head dislocation with an intact annular ligament is uncommon. This pattern allowed a single reconstruction with two plates without a radio-ulnar screw.

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Irreducible Traumatic Radial Head Dislocation Due to Annular Ligament Interposition in a Child with Ulnar Plastic Deformation: A Case Report

Orthopaedic Surgery ◽

10.1111/os.12981 ◽

2021 ◽

Author(s):

Dung T Tran ◽

Nam T Vu ◽

Quynh T Nguyen ◽

Toan D Duong ◽

Du G Hoang ◽

...

Keyword(s):

Plastic Deformation ◽

Case Report ◽

Radial Head ◽

Annular Ligament ◽

Radial Head Dislocation

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Treatment of missed Monteggia lesion in children: Case report

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1102099v ◽

2011 ◽

Vol 139 (1-2) ◽

pp. 99-102

Author(s):

Zoran Vukasinovic ◽

Vesna Jovanovic ◽

Desanka Mitrovic ◽

Nemanja Slavkovic

Keyword(s):

Radial Head ◽

Treatment Process ◽

Annular Ligament ◽

Ilizarov Method ◽

Radial Head Dislocation ◽

Bone Maturation ◽

Joint Opening ◽

Monteggia Lesion ◽

Lesion Type ◽

Missed Monteggia

Introduction. A Monteggia lesion is a dislocation of the radial head associated with a fracture with the proximal third of the ulna. It is rare in children and the dislocation of the radial head is often missed at the time of injury. There are a lot of described treatment methods: open reduction of the radial head and reconstruction of the annular ligament combined with ulnar osteotomy, the same method without reconstruction of the annular ligament, gradual lengthening and angulation of the ulna by Ilizarov method without the opening of radiocapitelar joint. Case Outline. A 14-year-old boy had been diagnosed with Monteggia lesion type Bado II three years before the admission to hospital. Previously nonoperatively treated, the missed radial head dislocation Bi-phase treatment had been done. Firstly, the distraction Ilizarov device was placed on the forearm, corticotomy of the ulna was done, distraction lasted fifteen days. Secondly, after achieving 1.5 cm of new bone and good level of the radial head, a reduction mechanism was incorporated into the Ilizarov device. The radiocapitelar joint was not opened, the reconstruction of the annular ligament was not done. After the radial head reduction and new bone maturation (1.5 months), the Ilizarov device was taken off. Conclusion. The described method of treatment has several important advantages: radial head reduction may be done without the joint opening, the recovery is very fast and easy after that; the elbow and forearm appear cosmetically very well after the operation; the treatment process is short, the arm is in use all the time, the absence from school is not needed, the achieved result is permanent.

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Isolate and irreducible radial head dislocation in children: a rare case of capsular interposition

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03685-5 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Luigi Tarallo ◽

Michele Novi ◽

Giuseppe Porcellini ◽

Fabio Catani

Keyword(s):

Radial Head ◽

Soft Tissues ◽

Biceps Tendon ◽

Annular Ligament ◽

Neutral Position ◽

Radial Head Dislocation ◽

Anterior Capsule ◽

Associated Lesions ◽

Sport Activities ◽

Tendon Interposition

Abstract Background Radial head dislocation with no associated lesions, is a relatively uncommon injury in children. In this case report, it is reported a case of anteromedial locked radial head dislocation in children, and we discuss its clinical presentation and pathogenetic mechanism of injury. Case presentation An 8-year-old girl fell off on her right forearm with her right elbow extended in hyperpronation. An isolated radio-capitellar dislocation was identified with no other fractures or neurovascular injuries associated. Elbow presented an extension-flexion arc limited (0°- 90°), and the prono-supination during general anesthesia shows “a sling effect” from maximal pronation (+ 55°) and supination (+ 90°) to neutral position of forearm. The radial head dislocation was impossible to reduce and an open reduction was performed using lateral Kocher approach. The radial head was found “button-holed” through the anterior capsule. The lateral soft tissues were severely disrupted and the annular ligament was not identifiable. Only by cutting the lateral bundle of the capsule was possible to reduce the joint. At 50 moths follow-up, patient presented a complete Range of motion (ROM), complete functionality and no discomfort or instability even during sport activities. Discussion and conclusion It is important to understand the pathogenic mechanisms of locked radial head dislocation in children. Some mechanism described are the distal biceps tendon or the brachialis tendon interposition. However even the anterior capsule can hinder reduction. A characteristic “sling-effect” of the forearm could be pathognomonic for capsular button-holing. Surgical release of the capsular bundle sometimes is the only way to reduce the dislocation and obtain a good outcome.

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Ipsilateral Pediatric Supracondyar Humerus Fracture and Radial Head Dislocation

Case Reports in Orthopedic Research ◽

10.1159/000495358 ◽

2018 ◽

Vol 1 (1-3) ◽

pp. 62-66

Author(s):

Daniel C. Kim ◽

Adam J. Handwerger ◽

John T. Riehl

Keyword(s):

Radial Head ◽

Closed Reduction ◽

Pediatric Patients ◽

Humerus Fracture ◽

Radial Head Dislocation ◽

Supracondylar Humerus Fracture ◽

Left Elbow ◽

One Year

Case: A 5-year-old boy presented with left elbow pain after a fall. Radiographs revealed a radial head dislocation without ulnar involvement which was treated with closed reduction in the emergency department. Two-week follow-up radiographs revealed a periosteal reaction along the medial epicondyle at the supracondylar region, consistent with a type 1 supracondylar humerus fracture. The elbow was treated with closed reduction and casting for 2 weeks. One year after injury, the patient had full painless range of motion. Conclusion: This case report highlights an injury pattern not previously described in the literature, and no previous recommendations exist regarding treatment. Although rare, radial head dislocation with simultaneous supracondylar humerus fracture can occur in pediatric patients. Our patient obtained a good result without surgical treatment.

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RADIAL HEAD DISLOCATION AS A RARE COMPLICATION OF OBSTETRIC BRACHIAL PLEXUS PALSY: LITERATURE REVIEW AND FIVE CASE SERIES

Hand Surgery ◽

10.1142/s0218810412500050 ◽

2012 ◽

Vol 17 (01) ◽

pp. 33-36 ◽

Cited By ~ 1

Author(s):

Cecilia W. Huo

Keyword(s):

Brachial Plexus ◽

Radial Head ◽

Biceps Tendon ◽

Rare Complication ◽

Case Series ◽

Annular Ligament ◽

Radial Head Dislocation ◽

Brachial Plexus Palsy ◽

Obstetric Brachial Plexus Palsy ◽

Obstetric Brachial Plexus

Radial head dislocation secondary to obstetric brachial plexus palsy is a rare complication that may occur a few years after birth. Five cases were examined and a comprehensive literature search was performed. Although it is a concern for parents, the dislocation resulted in mild or minimal functional impairment for all five children. Surgical interventions such as biceps tendon transfer, radial head open reduction or excision and annular ligament reconstruction were largely ineffective in significantly improving ranges of motion. Clinicians should be aware of the potentially futile outcomes and risks associated with the surgical treatment of radial head dislocation.

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Radial Head Dislocation Due to Gigantic Solitary Osteochondroma of the Proximal Ulna: Case Report and Literature Review

Hand ◽

10.1007/s11552-014-9610-5 ◽

2014 ◽

Vol 10 (2) ◽

pp. 305-308 ◽

Cited By ~ 1

Author(s):

Yoshitaka Hamada ◽

Naohito Hibino ◽

Emiko Horii

Keyword(s):

Case Report ◽

Literature Review ◽

Radial Head ◽

Radial Head Dislocation ◽

Proximal Ulna ◽

Solitary Osteochondroma

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A comparison of partial inferior turbinectomy and cryosurgery for hypertrophic inferior turbinates

The Journal of Laryngology & Otology ◽

10.1017/s0022215100134826 ◽

1996 ◽

Vol 110 (8) ◽

pp. 732-735 ◽

Cited By ~ 52

Author(s):

Yoseph Rakover ◽

Gabriel Rosen

Keyword(s):

Success Rate ◽

Surgical Procedures ◽

Postoperative Morbidity ◽

Simple Procedure ◽

Functional Results ◽

Effective Therapy ◽

Outpatient Basis ◽

One Year

AbstractA variety of surgical procedures are performed for treatment of hypertrophic inferior turbinates, but there is no completely effective therapy. We evaluated subjectively and objectively 52 patients who underwent one of two procedures: partial inferior turbinectomy (PIT) or cryosurgery of the inferior turbinates (CS). The results of PIT showed good functional results in 77 per cent of cases for long-term effectiveness. The results of CS showed that effectiveness was reduced from a 62 per cent success rate after one year to 35 per cent later, but CS was a simple procedure which was performed on an outpatient basis with no postoperative morbidity.

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Surgical treatment of chronic anterior radial head dislocations in missed Monteggia lesions in children: A rationale for treatment and pearls and pitfalls of surgery

Shoulder & Elbow ◽

10.1177/1758573219839225 ◽

2019 ◽

Vol 12 (6) ◽

pp. 422-431

Author(s):

LC Langenberg ◽

ACH Beumer ◽

B The ◽

KLM Koenraadt ◽

D Eygendaal

Keyword(s):

Range Of Motion ◽

Radial Head ◽

Ligament Reconstruction ◽

Annular Ligament ◽

Proximal Ulna ◽

Monteggia Lesion ◽

Ulna Osteotomy ◽

Annular Ligament Reconstruction ◽

Monteggia Lesions ◽

Missed Monteggia

Introduction The treatment of chronic radial head dislocations after Monteggia lesions in children can be challenging. This article provides a detailed description of the most frequently performed surgical technique: an ulna osteotomy followed by annular ligament reconstruction. Accordingly, we present the clinical and radiological results of 10 paediatric cases. Material and methods All paediatric patients that had a corrective osteotomy of the ulna for a missed Monteggia lesion between 2008 and 2014 were evaluated with standard radiographs and clinical examination. A literature search was performed to identify the relevant pearls and pitfalls of surgery. Primary outcome was range of motion. Results We included 10 patients, with a mean follow-up of 2.5 years. Postoperative range of motion generally improved 30.7°. Even in a patient with obvious deformity of the radial head, range of motion improved after surgery, without residual dislocation of the radial head. Conclusion Corrective proximal ulna osteotomy with rigid plate fixation and annular ligament reconstruction yields good results in patients with chronic radial head dislocation following a Monteggia lesion. Surgery should be considered regardless of patient age or time since trauma. Given substantial arguments in literature, we discourage surgery if a CT scan shows dome-shaped radial head dysmorphic features in work-up to surgery.

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