Anterior Dislocation Of Radial Head Research Articles

Navigating Isolated Post-Traumatic Radial Head Dislocation in Adolescents: A Case Report from Bangladesh Emphasizing Management Strategies

Background: Isolated anterior dislocation of the radial head is a rare orthopedic injury, oftenpresenting with distinct clinical features and requiring specialized management. We report the case of an 18-year-old female who presented to our hospital 5 months post-injury, complaining of restricted left elbow joint movement and pain following a fall from a low chair at home. Clinical examination revealed tenderness and anterior dislocation of the radial head, confirmed by radiographs showing isolated anterior dislocation without associated fractures. Closed reduction attempts failed, leading to an open reduction of radial head in combination with correction of malignant with ulnar osteotomy and reconstruction of annular ligament and radio-ulnar Kirschner wire placement for stabilization. An upper arm cast was applied with the forearm in neutral rotation for six weeks. At the 12-month follow-up, the patient exhibited a satisfactory range of motion within reference values, comprising 0-140 degrees of flexion-extension arc, 70 degrees of pronation, and 85 degrees of supination. This range aligned with standards set by the American Society for Surgery of the Hand. The patient reported no impediments in daily activities and returned to her pre-injury level of sports activity based on the Tegner scale. This case underscores the complexity of managing isolated anterior radial head dislocation, highlighting the significance of prompt diagnosis, appropriate reduction techniques, and meticulous postoperative care to achieve optimal functional outcomes. Central Medical College Journal Vol 7 No 1 January 2023 Page: 57-62

Isolated post-traumatic anterior radial head dislocation in adult: A very rare injury

Isolated anterior radial head dislocations are rare injuries. Few cases have been reported in the literature. Most patients are diagnosed late with restricted forearm rotations. In this report, we provide the details of an isolated radial head anterior dislocation with Mason type 1 radial head fracture in an adult.

Congenital anterior radial head dislocation with valgus deformity: A case report

Congenital radial head dislocation is a rare anomaly of the pediatric musculoskeletal system. The most common type is posterior, with anterior and lateral dislocations being less common. Unilateral cases are even more uncommon and were earlier thought to be non-existent. Our case report describes a young girl with unilateral congenital anterior radial head dislocation with progressive development of cubitus valgus deformity, which is a very rare occurrence. On reviewing literature, only few such cases have been described. Our patient also had a history of developmental dysplasia of hip and a congenital intra-hepatic porto-systemic shunt, which in addition to the morphological appearances of the radial head and capitellum, suggested a congenital etiology.

Monteggia fracture dislocation equivalent in children: A rare case report

Monteggia fractures account for less than 1% of all paediatric elbow dislocations, with a peak age of 4 to 10 years. Although rare, they receive considerable interest because they are often missed, resulting in poor outcomes. There have been numerous reports of Monteggia equivalents including the three most common- isolated radial head dislocation, fracture of the proximal ulna with fracture of the radial neck and both bone proximal third fractures with radial fracture more proximal than the ulnar fracture. We present a case of 6 year old boy with minimally comminuted metaphyseal fracture of ulna extending to proximal diaphysis with anterior dislocation of radial head managed by closed reduction and fixation by percutaneous Kirschner-Wires.

Acute ulnar osteotomy versus gradual distraction by external fixator to correct missed monteggia type 1 fracture-dislocation; A comparative study

Background: Monteggia fracture-dislocations are complex injuries. These injuries, especially neglected ones, remain a challenge for orthopedic surgeons. The aim of this study is to compare the results of acute and gradual ulnar lengthening osteotomies in treating chronic Monteggia fractures in children. Patients and Methods: The study includes two groups of patients, treated at our institution in the period from April 2014 to September 2018. The first group (Group A) included nine patients who were treated by an overcorrective ulnar osteotomy with acute lengthening with bone grafting. The second group (B) includes 11 children who were treated by Ilizarov distraction osteogenesis for differential lengthening of forearm bones. There were 14 boys and 6 girls. The left elbow was involved in five patients and the right elbow 15 patients. All fractures were classified as Bado type I with anterior radial head dislocation. The average age at the time of surgery was 7 years and 4 months. Results: The mean interval from the injury to surgical interference was 8.6 months. There was a significant improvement of the elbow range of motion and Mayo elbow performance score. In group B, the mean external fixation time was 9.7 weeks (range from 9 to 15 weeks). The mean total treatment time was 12.3 weeks (ranged from 12 to 16 weeks). Superficial pin-tract infection occurred in all cases and was managed without further sequelae. Conclusions: Both approaches yielded equally good results. The open surgery approach entails a more invasive procedure, but more convenient to the patient and no arduous postoperative follow-up is needed. On the contrary, differential lengthening of forearm bones is a percutaneous procedure with the application of Ilizarov principles in a controlled biological manner; with no graft materials needed. Both techniques effectively reduced the radial head.

An atypical type of Monteggia equivalent: A case report

Monteggia fracture dislocations comprise about 5-10 % of all forearm fractures in adults and was first described in 1814. Since then there has been many descriptions of Monteggia equivalents. We present a case of 47 year old adult with segmental comminuted fracture of ulna with anterior radial head dislocation managed by closed intramedullary nailing. We further propose that based on the basis of its features and mechanism of injury.

Delayed treatment of a neonatal type-I Monteggia fracture-dislocation: a case report

Delayed diagnosis of a Monteggia fracture-dislocation changes a straightforward, treatable injury into a complex problem. Acute neonatal injuries may be missed because of the inability to visualize the unossified skeleton on radiography, interpreted later as 'congenital' dislocations. We report the case of a 14-month-old with a neonatal Monteggia type-I fracture-dislocation secondary to birth trauma, with anterior radial head dislocation and plastic deformation of the ulna. Uniplanar external fixation was used to restore ulnar length and correct angulation, with subsequent radiocapitellar joint closed reduction. Joint congruity was maintained at the 2-year follow-up, with articular remodeling shown on serial arthrogram.

Isolated Traumatic Chronic Anterior Dislocation of Radial Head

Isolated Traumatic Chronic Anterior Dislocation of Radial Head

Biomechanical study of isolated radial head dislocation

BackgroundIsolated radial head dislocation is a rare injury with an unclear pathomechanism, and the treatment is controversial. The purpose of the present study was to investigate the biomechanical contributions of the annular ligament, quadrate ligament, interosseous membrane, and annular ligament reconstructions to proximal radioulnar joint stability.MethodsFive fresh frozen cadaveric upper extremities were amputated above the elbow and solidly fixed on a customized jig. Radial head dislocation was reproduced by sequential sectioning of ligamentous structures and passive mobility testing. Radial head displacement during mobility testing was measured with an electromagnetic tracking device in three forearm rotation positions. The data were compared among different sectioning stages and between two types of simulated ligamentous reconstruction.ResultsLateral displacement of the radial head significantly increased in the neutral forearm rotation after annular ligament sectioning (46 ± 10%, p < 0.05). After quadrate ligament sectioning, we found significant posterior (67 ± 36%, p < 0.05) and lateral (74 ± 24%, p < 0.01) displacement in neutral forearm rotation and pronation. Significant radial head displacement was found in all directions and in all forearm positions after sequential sectioning of the proximal half of the interosseous membrane. Anatomical annular ligament reconstruction stabilized the proximal radioulnar joint except for anterior laxity in neutral forearm rotation (15 ± 6%, p < 0.05). The radial head with Bell Tawse procedure was significantly displaced in all directions.ConclusionThe direction of radial head instability varied depending on the degree of soft tissue sectioning and specific forearm rotation. Anterior radial head dislocation may involve more severe ligament damage than other types of dislocation. Anatomical annular ligament reconstruction provided multidirectional radial head stability.

Anterior Dislocation of Radial Head Caused by Arm Wrestling; A Case Reports

Anterior Dislocation of Radial Head Caused by Arm Wrestling; A Case Reports

"Sliding angulation osteotomy": preliminary report of a novel technique of treatment for chronic radial head dislocation following missed Monteggia injuries.

Neglected anterior radial head dislocation in type I Monteggia lesions leads to restriction of movement, deformity and instability of the affected elbow. If left untreated this leads to a painful arthritic elbow due to secondary degenerative changes. This is a difficult problem to manage and many intra-articular, extra-articular and combined procedures have been described with variable results. We report a new technique of sliding angulation osteotomy for this condition, which allows both lengthening and angulation of the ulna. A novel technique of sliding angulation osteotomy of the proximal ulna was done to achieve reduction of the radial head. Four patients with persistent anterior radial head dislocation were treated at our institution with this technique. All of them had good clinical and radiological outcomes at final follow-up. Sliding angulation osteotomy is a technically simple procedure, which achieves lengthening and angulation of the ulna simultaneously in the sagittal plane and reduces the radial head.

Acute Traumatic Irreducible Anterior Dislocation and Fracture of the Radial Head in an Adult

Traumatic dislocation of the radial head without fracture of the olecranon is very rare, especially in adults. We experienced a case of irreducible radial head dislocation with fracture without involvement of ulna. Open reduction and internal fixation was performed. During surgery, brachialis was interposed between capitellum and radial head, and also interposed between the fragments at the fracture site of the radial head. At 12 months after operation, the radial head was well reduced with normal rotation.

Long-term outcome after ulnar osteotomy for missed Monteggia fracture dislocation in children

Missed Monteggia fracture dislocation in children is a serious condition. The treatment of this rare condition is controversial and reports on the long-term outcome are sparse. We present a series of patients treated with open reduction and ulnar osteotomy with a mean long-term follow-up of 8years (range 3-17). All 16 patients had Bado type 1 (anterior radial head) dislocation. The mean delay from injury to surgery was 17months (range 1-83). Bilateral radiographs, Oxford Elbow Score, strength measurements, and range of motion were obtained in all patients. There were no major complications to surgery. The radiographic results showed ten patients with reduction of the radial head and with no arthrosis, four patients with arthrosis or subluxation, and two patients with a dislocated radial head. We found a significant correlation between radiographic outcome and delay to ulnar osteotomy (P=0.03). Typical clinical findings were a small but significant extension deficit and mean loss of supination of 10° (range 0-90, P<0.01). Ligament reconstruction or transfixation of the radial head did not influence the radiographic or clinical outcome. Case reports of similar patients treated conservatively demonstrate high morbidity, and, therefore, open reduction and ulnar osteotomy seemed justified. However, this study underlines the importance of minimizing the delay between injury and ulnar osteotomy. If surgery is performed within 40months after injury, good to fair long-term radiographic results can be obtained. Open reduction and ulnar osteotomy were performed because patients treated conservatively demonstrate high morbidity.

Acute persistent traumatic anterior dislocation of the fractured radial head: a case report and surgical technique

Anterior dislocations of the radial head are relatively uncommon in adults and usually occur as a result of highenergy trauma in young patients. Treatment of these injuries is often difficult because the lateral collateral ligamentous complex of the elbow is severely damaged andmaintenance of the reduction can prove challengingwithout the aid of this soft tissue constraint. Conservative treatment involves prolonged immobilization of the elbow joint once reduction has been achieved, leading to stiffness and severe disability. Surgical options to maintain the reduction include direct repair of the lateral collateral ligamentous complex, but this structure is often extensively disrupted after severe trauma, and the option is not viable. Another surgical option is a hinged external fixator, which is minimally invasive and allows early motion. However, the fixator pins pose an infection risk, are prone to loosening particularly in osteoporotic bone, may injure adjacent neurovascular structures, and the device may not be well tolerated by the patient. We present a patient with a radial head fracture dislocation and a novel surgical technique for maintaining this reduction.

Chronic Posttraumatic Anterior Dislocation of the Radial Head in Children: Thirteen Cases Treated by Open Reduction, Ulnar Osteotomy, and Annular Ligament Reconstruction Through a Boyd Incision

Chronic Posttraumatic Anterior Dislocation of the Radial Head in Children: Thirteen Cases Treated by Open Reduction, Ulnar Osteotomy, and Annular Ligament Reconstruction Through a Boyd Incision

Unusual anterior radial head dislocation associated with transposed biceps tendon: A case report

ASE REPORT A 12-year-old girl fell from a ladder, landed on the round, and twisted her right forearm with her right elbow xtended. Her right elbow was swollen and painful, but here were no signs of neurologic or vascular injury. Withut delay, she went to the hospital. Radiographs of the lbow taken immediately after the injury showed an anteior radial head dislocation and fracture in the medial picondyle of the humerus (Figure 1). Radiographs of the orearm were not taken. The patient underwent operation nder general anesthesia on the same day of the injury. eduction of the radial head, by use of an image intensifier, as performed via a lateral approach with a small splitting f the common extensors. The reduced radial head was nstable. However, exposure of the radiocapitellar joint as not done, and transcapitellar Kirschner wire fixation as performed to stabilize the reduced radial head (Figure ). The medial epicondyle fracture was treated by open eduction–internal fixation by use of a single pin and suplemental steel wire via a medial approach (Figure 2). ostoperatively, an above-elbow cast immobilization was pplied. Six weeks after the operation, the cast and trancapitellar Kirschner wire were removed at the same time, nd active elbow movements were then begun. However, adiographs of the elbow 7 weeks postoperatively showed n anterior radial head dislocation. At 9 weeks 6 days after the initial operation, the patient as referred to our department for further examination and reatment. On initial examination, the radial head was alpable with tenderness in the antecubital fossa. Flexion/ xtension of the elbow was 90°/ 50°, and pronation/

Congenital anterior dislocation of the radial head: a case with radiographic findings identical to traumatic dislocation

Differentiation of congenital unilateral dislocation of the radial head from a traumatic dislocation depends mainly on the radiographic findings. Here, we report a case of congenital unilateral anterior radial head dislocation with radiographic findings identical to traumatic dislocation.

Voluntary dislocation of the radial head

CASE REPORT A 28-year-old right-handed man came to our hospital with snapping of his right elbow with powerful flexion. He also described an unbearable dull pain in his forearm while he attempted to write. He had practiced karate for 2 years, from the ages of 10 to 12 years, and had had episodes of minor repetitive trauma while performing the sport. However, he had never had any significant trauma to the elbow. The patient had first had dull pain in the forearm when he was 16 years old. His symptoms persisted and became more severe. When he was 22 years old he began to have difficulty writing because of worsening pain in the right forearm. The pain became so disabling that the patient had to cease all writing. The range of motion of the elbow was from 0 ~ to 145 ~ of flexion. Supination was 90 ~ and pronation was 65 ~ The carrying angle of the right elbow was normal and symmetric with that of the left elbow. Valgus instability was present on manual stress testing. The patient had voluntary anterior radial head dislocation when his elbow was flexed 90 ~ or greater against an applied resistive force to the forearm. A prominent snapping occurred with the dislocation. Spontaneous reduction of the radial head occurred when con-

Developmental dislocation of the radial head

An unusual case of developmental dislocation of the radial head is reported. A 6-year-old boy was referred for evaluation of his elbow and was diagnosed as having an anterior dislocation of the right radial head. No dislocation was present on the left. Subsequently, the left radial head dislocated anteriorly without associated trauma 1 year after the initial examination. Intraoperative findings on the right revealed the dislocation occurred during pronation of the forearm when the radius abutted the interosseous border of the ulna. Ulnar osteomy and reinstruction of the annular fragment were performed but were, not effective in preventing redislocation.

Old Unreduced Isolated Anterior Dislocation of Radial Head: Report of 2 Cases

Old Unreduced Isolated Anterior Dislocation of Radial Head: Report of 2 Cases