Surgical Treatment for Chronic Anterior Dislocation of the Radial Head.

Abstract

Background: Surgical correction of chronic anterior dislocation of the radial head in paediatric patients is challenging, and they may experience re-dislocation or subluxation even after corrective surgery. We have been performing a radial shortening osteotomy combined with reconstruction of the annular and lateral collateral ligaments, and a corrective osteotomy of the ulna. The aim of this article is to describe our technique and outcomes at mid-term follow-up. Methods: This retrospective review included 10 paediatric patients with chronic anterior dislocation of the radial head that were surgically treated at our unit from January 2016 to July 2022. The dislocations were congenital in two patients, resulted from neglected Monteggia fractures in seven patients, and was idiopathic in one patient. The average age at surgery was 8.3 years. All patients underwent radial shortening osteotomy combined with reconstruction of the annular and lateral collateral ligaments, and a corrective osteotomy of the ulna. Outcomes with regards to period of follow-up, complications, arc of motion and the Kim elbow performance score were assessed. Results: The reduction of the radial head was maintained at the final follow-up (mean: 55 months). No acute or chronic complications occurred. The mean arc of flexion-extension improved from 124° to 140° while the arc of prono-supination decreased from 124° to 113°. The Kim elbow performance score was excellent in eight patients, fair in one and poor in one. Conclusions: A combination of radial shortening osteotomy, reconstruction of the annular and lateral collateral ligaments and corrective osteotomy of the ulna was able to maintain a stable reduction of the radial head with satisfactory elbow motion in the mid-term in paediatric patients with chronic anterior dislocation of the radial head regardless of the underlying cause. Level of Evidence: Level IV (Therapeutic).