Radial Head Dislocation Research Articles

Effects of obtaining plain radiographs in pediatric patients with radial head subluxation

Effects of obtaining plain radiographs in pediatric patients with radial head subluxation

Biallelic variants in CCN2 underlie an autosomal recessive kyphomelic dysplasia.

Kyphomelic dysplasia is a rare heterogenous group of skeletal dysplasia, characterized by bowing of the limbs, severely affecting femora with distinct facial features. Despite its first description nearly four decades ago, the precise molecular basis of this condition remained elusive until the recent discovery of de novo variants in the KIF5B-related kyphomelic dysplasia. We ascertained two unrelated consanguineous families with kyphomelic dysplasia. They had six affected offsprings and we performed a detailed clinical evaluation, skeletal survey, and exome sequencing in three probands. All the probands had short stature, cleft palate, and micro-retrognathia. Radiographs revealed kyphomelic femora, bowing of long bones, radial head dislocations and mild platyspondyly. We noted two novel homozygous variants in CCN2 as possible candidates that segregated with the phenotype in the families: a missense variant c.443G>A; p.(Cys148Tyr) in exon 3 and a frameshift variant, c.779_786del; p.(Pro260LeufsTer7) in exon 5. CCN2 is crucial for proliferation and differentiation of chondrocytes. Earlier studies have shown that Ccn2-deficient mice exhibit twisted limbs, short and kinked sterna, broad vertebrae, domed cranial vault, shorter mandibles, and cleft palate. We studied the impact of CCN2 knockout in zebrafish models via CRISPR-Cas9 gene editing. F0 knockouts of ccn2a in zebrafish showed altered body curvature, impaired cartilage formation in craniofacial region and either bent or missing tails. Our observations in humans and zebrafish combined with previously described skeletal phenotype of Ccn2 knock out mice, confirm that biallelic loss of function variants in CCN2 result in an autosomal recessive kyphomelic dysplasia.

Surface electromyography character of upper limb muscle after open reduction combine with ulnar osteotomy in children with neglected Monteggia fracture

ObjectiveThis study aims to investigate the surface electromyography (sEMG) characteristics of upper limb muscles in children with neglected Monteggia fracture after open reduction of radial head dislocation and ulna osteotomy and bone grafting internal fixation, and to understand the recovery of muscle activity in children after operation, provide reference for clinical rehabilitation.MethodsA retrospective analysis was conducted on sixteen children with neglected Monteggia fracture who underwent ulna osteotomy at our hospital from January 2021 to August 2022. The biceps brachii, triceps brachii, flexor carpi radialis, and extensor carpi ulnaris muscle activities were recorded during grip strength tests, flexion and extension of elbow joint while holding a 1 kg dumbbell, as well as gripping tasks. The root mean square (RMS) values of sEMG signals, co-contraction ratio, and elbow joint function scores were compared between pre- and post-operation periods as well as between the affected side and unaffected side.ResultsThe preoperative maximum grip strength, as well as the average RMS values of flexor carpi radialis and average RMS value of extensor carpi ulnaris on the affected side were significantly lower. After surgery, both the maximum RMS value of biceps brachii and maximum and average RMS value of extensor carpi ulnaris on the affected side remained lower. Prior to surgery, when performing elbow flexion and extension tests while holding a 1 kg dumbbell, both mean RMS values of biceps brachii and flexor carpi radialis on the affected side were smaller. However, after surgery, there was an increase in mean RMS values of biceps brachii on the affected side. Furthermore, postoperative elbow function scores were significantly higher than preoperative scores.ConclusionOpen reduction of radial head dislocation combined with ulna osteotomy and bone grafting can achieve good functional activities in the treatment of neglected Monteggia fractures in children. The EMG activity of the extensor carnosus ulnalis muscle on the affected side related to grip strength was low, and the desired effect was not achieved within the expected time.

Tendon Lengthening Surgery for Elbow Flexion Contractures in Brachial Plexus Birth Palsy

Flexion contracture of the elbow is a common deformity associated with brachial plexus birth palsy and is often managed with preventive night orthoses. For severe cases, however, surgical interventions may become necessary. This study evaluated the effectiveness of surgically releasing elbow flexion contractures exceeding 30° through partial tenotomy of the brachialis and biceps brachii muscles, along with a division of the lacertus fibrosus. We performed 36 anterior elbow releases on patients with injury to the upper trunk (C5-C6) of the brachial plexus and elbow flexion contractures between 30° and 80°. All releases involved lacertus fibrosus section and partial lengthening of the distal portion of the brachialis tendon. In severe cases, biceps brachii tenotomy was also performed. All participants had a minimum follow-up of 12 months and preoperative elbow flexion strength of at least grade 4 on the British Medical Research Council scale, with no deformities in the shape of the ulnohumeral joint or radial head subluxation. Following a mean follow-up of 41 months, the average extension gain was 31° (range, 10°-50°). All patients maintained their flexion strength. Except for two participants with weaker triceps, the mean elbow extension gain was sustained throughout the follow-up period. There were no major or minor complications or reinterventions in the study. Partial tenotomy of the brachialis and biceps brachii muscles, coupled with lacertus fibrosus section, is an effective treatment for elbow contractures exceeding 30° flexion. This method is successful in individuals with a functioning triceps brachii and elbow extension strength of at least grade 3 on the British Medical Research Council scale. Therapeutic IV.

Metaizeau technique in stabilizing Monteggia equivalent 1b associated proximal radial physeal injury in a rural setting: a case report

Introduction: The Monteggia equivalent type 1b fracture, consisting of an ulnar shaft fracture and radial head dislocation, is a rare condition first described by Giovanni Battista Monteggia. The Metaizeau technique, emphasizing percutaneous intramedullary fixation to preserve bone healing and prevent growth plate damage, has gained prominence in managing these fractures. Case report: A 10-year-old boy presented with left forearm pain, swelling, and deformity following a fall while playing football. X-rays revealed a proximal fourth ulnar fracture with dorsal and lateral angulation, along with a proximal radial metaphyseal fracture showing anterior rotation and physeal extension. This fracture pattern resembled a Monteggia fracture type III but differed in the lateral proximal radial disruption via a Salter–Harris type II fracture rather than radial epiphysis dislocation. Satisfactory reduction achieved for ulna was managed with standard nailing system but could not be achieved for radial physeal injury, which was managed with Metaizeau technique. Discussion: Type 1b Monteggia equivalents involving a Salter–Harris type 2 fracture of the proximal radius with an associated proximal ulnar fracture, adherence to Monteggia fracture reduction principles is vital. Closed reduction and internal fixation are preferred treatments, with the Metaizeau technique offering advantages such as minimal invasiveness and avoidance of implant-related complications. The Metaizeau technique is particularly beneficial for displaced radial neck fractures in children, providing stable fixation while preserving the fracture environment necessary for optimal healing. Conclusion: In cases of Monteggia fracture equivalents, most proximal radial fractures typically reduce to an acceptable level following ulnar reduction. However, proximal radial physeal fractures may require specific attention to achieve satisfactory reduction. The Metaizeau technique, commonly employed in the management of isolated radial neck fractures, can be utilized to achieve this reduction to an acceptable level.

Ulnar lengthening for children with forearm deformity from hereditary multiple exostoses: a retrospective study from a tertiary medical center

BackgroundPatients with hereditary multiple exostosis (HME) usually present with forearm deformity with or without radial head dislocation. Ulna lengthening has been proposed to address this condition. Exostosis resection plus ulna lengthening has been adopted in our hospital since 2008, and patients with this condition were retrospectively reviewed. Herein, we aimed to investigate the optimal timing and clinical outcomes of this surgical approach.MethodsIn all, thirty-five patients (40 forearms), including 22 boys and 13 girls, were enrolled in our study from July 2014 to September 2020. We divided the patients into 4 groups based on the age when they received surgery and the status of the radial head. Pronation and supination of the forearm, flexion and extension of the elbow, wrist ulnar deviation and wrist radial deviation, and radiological parameters including ulnar length (UL), ulnar variance (UV), the percentage of radial bowing (RB/RL), radio articular angle (RAA) and carpal slip (CS), were assessed and recorded.ResultsThe mean UL was significantly improved after surgery in four Groups (P<0.05). In patients with radial head dislocation, we found significant improvement in forearm, wrist function and elbow flexion (p < 0.05). For the patients with radial head dislocation, the juniors demonstrated better improvement in % RB and RAA (p<0.05, p = 0.003 and 0.031).ConclusionExostosis resection and ulna lengthening with unilateral external fixation can effectively improve the function and radiological parameters of forearm deformity in HME children. For patients with radial head dislocation, early surgery can achieve better results. For patients not associated with radial head dislocation, we recommend regular follow-up and surgical treatment after 10 years of age.

Clinical, Radiographic, and Biomechanical Evaluation of the Upper Extremity in Patients with Osteogenesis Imperfecta.

Introduction: Osteogenesis imperfecta (OI) is a hereditary disorder primarily caused by mutations in type I collagen genes, resulting in bone fragility, deformities, and functional limitations. Studies on upper extremity deformities and associated functional impairments in OI are limited. This cross-sectional study aimed to evaluate upper extremity deformities and functional outcomes in OI. Methods: We included patients regardless of their OI subtypes with a minimum age of 7 years. Radiographic analysis of radial head dislocation, ossification of the interosseous membrane, and/or radioulnar synostosis of the forearm were performed, and deformity was categorized as mild, moderate, or severe. Clinical evaluation was performed using the Quick Disabilities of Arm, Shoulder, and Hand (qDASH) questionnaire and shoulder-elbow-wrist range of motion (ROM). Three-dimensional motion analysis of the upper limb was conducted using the Southampton Hand Assessment Procedure (SHAP). The SHAP quantifies execution time through the Linear Index of Function (LIF) and assesses the underlying joint kinematics using the Arm Profile Score (APS). Additionally, the maximum active Range of Motion (aRoM) was measured. Results: Fourteen patients aged 8 to 73 were included. Radiographic findings revealed diverse deformities, including radial head dislocation, interosseous membrane ossification, and radioulnar synostosis. Six patients had mild, six moderate, and two severe deformities of the upper extremity. Severe deformities and radial head dislocation correlated with compromised ROM and worse qDASH scores. The qDASH score ranged from 0 to 37.5 (mean 11.7). APS was increased, and LIF was reduced in OI-affected persons compared with non-affected peers. APS and LIF also varied depending on the severity of bony deformities. aRoM was remarkably reduced for pro-supination. Conclusion: Patients with OI showed variable functional impairment from almost none to severe during daily life activities, mainly depending on the magnitude of deformity in the upper extremity. Larger multicenter studies are needed to confirm the results of this heterogeneous cohort. Level of evidence: Retrospective clinical study; Level IV.

Predictors of Radial Head Dislocation in Patients with Multiple Hereditary Exostoses.

Background: Radial head dislocation in patients with multiple hereditary exostoses (MHE) is associated with loss of function and cosmetic problems. The treatment of the deformity with radial head dislocation is difficult and the timing of surgical intervention is important. The aim of this study was to evaluate the factors predictive of radial head dislocation in patients with MHE. Methods: Patients diagnosed with forearm deformity due to MHE between 1995 and 2021 were retrospectively evaluated. Radiographic parameters including radial bow (RB), ulnar bow (UB), total radial bow (TRB), total ulnar bow (TUB), percent ulnar length (PUL), ulnar shortening (US), radial articular angle (RAA), modified Masada classification and irregularity of proximal radioulnar joint (PRUJ) of the dislocated group (group D), that is subluxation or dislocation of the radial head, and the located group (group L) were compared. Results: A total of 18 patients and 25 limbs (5 girls and 13 boys) with a mean age of 10.5 years were included. There were significant differences in TUB (22.8° ± 5.6° vs. 10.7° ± 6.5°), PUL (97.5% ± 5.5% vs. 108.2% ± 7.7%) between group D and group L (p < 0.05). Moreover, irregularity of PRUJ on radiographs was more in group D (p < 0.05). Conclusions: It is possible that appropriate radiographic assessment in relation to radial head dislocation may prevent delayed surgical treatment of forearm deformities in MHE. Level of Evidence: Level IV (Diagnostic).

A New Classification System for Forearm Deformities Caused by Hereditary Multiple Osteochondromas

The objective of this study was to evaluate the Masada and Jo classifications for clinical use in patients with forearm deformity caused by hereditary multiple osteochondroma and propose a new classification system that is all-inclusive and can guide clinical management. A retrospective review of 275 forearms was performed. A split-sample approach was used, where 138 forearms were analyzed to create a new classification, which was then validated on the remaining 137 forearms. Radiographs were reviewed to determine the number and location of osteochondromas and the presence of radial head dislocation (RHD) and to measure radiographic parameters. Multivariable logistic regression analysis was performed to identify radiological parameters associated with RHD. According to the Masada and Jo classifications, 95 of 275 forearms (34.5%) were unclassifiable. Analyses of the split group (n= 138) revealed 42 forearms with RHD. All these had distal ulna lesions, qualifying as the greatest associated factor for RHD. Further subgroup multivariable logistic regression analysis of forearms with distal ulna lesions identified radiological parameter proportional ulna length as a statistically significant association of RHD, qualifying as "at-risk" criteria. The area under the receiver operating characteristic curve for proportional ulna length was 0.89, with a receiver operating characteristic-derived ideal value of ≤ 0.95 (sensitivity 0.86 and specificity 0.86). We proposed a new classification system stratified into three groups-high, moderate, and low-risk of RHD-based on the identified factors associated with RHD. Type 1 comprises forearms with distal ulna osteochondromas-subdivided into type 1A (high-risk), where forearms meet the at-risk criteria for RHD and type 1B (moderate-risk), where forearms do not meet the at-risk criteria. Type 2 (low-risk) comprises forearms without distal ulna osteochondromas. Our classification system addresses the limitations of existing classifications by risk stratifying forearms into three groups-high, moderate, and low-risk of RHD.

Complex forearm deformities in brachial plexus birth palsy: Radial head dislocation, forearm bones crossing, and distal ulna volar dislocation

We present a rare and complex case involving a 6-year-old boy with brachial plexus birth palsy, which is complicated by secondary developmental changes such as proximal radial head dislocation, distal ulna dislocation, and a severe supination deformity in the forearm. Despite the severity of his condition, his parents declined further treatment. This case underscores the presence of unclassifiable complex anomalies and highlights the need to expand the current classification system, especially when these anomalies are associated with birth palsy. Our report emphasizes the importance of recognizing and addressing these intricate presentations to enhance diagnostic and therapeutic strategies.

Imaging Assessment of the Pediatric Elbow: Developmental Variants and Common Pathologies.

The pediatric elbow is a complex joint that undergoes rapid growth and development. The normal anatomy of the elbow varies depending on the age of the patient, which can be challenging for imaging interpretation. This article reviews developmental variants and common pathologies of the pediatric elbow, with a focus on their radiologic features. Normal anatomy and development of the pediatric elbow are discussed, including the six ossification centers and elbow alignment. Congenital anomalies such as longitudinal deficiencies of the upper extremity are reviewed. Some common injuries that affect the elbow, such as supracondylar fracture, lateral condyle fracture, medial epicondyle avulsion, and radial head dislocation are also described.

Ulnohumeral Cross-Pinning in the Management of Traumatic Elbow Instability

Traumatic elbow instability (subluxation and dislocation) represents a challenging clinical entity that can be complicated by persistent intraoperative instability after attempted stabilization or recurrent postoperative instability. Both static and dynamic supplemental stabilization procedures have been described for cases where fracture fixation and ligament repair fail to restore stability. There is a paucity of prior studies involving ulnohumeral cross-pinning (UCP), which is a type of static supplemental stabilization. Our purpose was to assess complications and outcomes after UCP. We reviewed all surgical cases involving primary and revision UCP for traumatic elbow instability at a single center from 2017-2023. Baseline demographics were recorded. Outcomes including radiographs, range of motion, patient-reported outcome measures, and surgical complications were analyzed. Fourteen patients undergoing UCP were included with a mean follow-up of 27 months. Five cross-pinnings (36%) were performed during revision procedures. Mean visual analog scale (VAS) pain, Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and the Single Assessment Numeric Evaluation (SANE) scores were 2.4, 34, and 69, respectively. The mean flexion-extension and pronation-supination arcs were 114° and 140°, with 85% achieving at least a 100° arc for flexion and forearm rotation. Five patients (36%) had complications, all of which required reoperation. Two complications involved postoperative instability: one radial head subluxation and one radial head dislocation. Both occurred in revision UCP cases indicated for recurrent postoperative instability. Ulnohumeral cross-pinning for persistent and recurrent elbow instability results in maintained ulnohumeral joint alignment, functional arcs of elbow range of motion, and acceptable patient-reported outcome measures, particularly in the setting of a primary procedure indicated for persistent intraoperative instability. Ulnohumeral cross-pinning is a reasonable supplemental stabilization procedure for complex elbow instability. Therapeutic IV.

Nursemaid's elbow: Radial head subluxation injuries in children.

Radial head subluxation, or nursemaid's elbow, is a common orthopedic complaint in children and often is the result of a pulling injury to the affected arm. Although this injury largely is a clinical diagnosis, different imaging modalities may be used to identify it and confirm successful reduction. Multiple manipulative techniques can be used to treat this injury and methods are generally specific to clinician preference. This article reviews the causes, evaluation, and management of radial head subluxation.

Posttraumatic proximal radioulnar synostosis: Current concepts on the clinical presentations, classifications, and open surgical approaches

In the forearm, posttraumatic heterotopic ossification usually forms as a proximal radioulnar synostosis. It can occur after soft tissue injury involving the interosseous membrane or after surgery involving the radio and ulna, such as distal biceps tendon repair. It can also be induced by radial head dislocation or fracture. Screening radiography can be used to select the appropriate time for excision. The synostosis can be resected when the ectopic bone margin and trabeculation appear mature on radiographs. An interval of 6–12 months from the injury is generally recommended based on ectopic bone maturity. Selection of the surgical approach depends on site, extension (elbow joint or proximal radioulnar joint), severity of the initial articular surface, and periarticular tissue injury. The posterolateral approach is indicated for synostoses: at or distal to the bicipital tuberosity, at the level of the radial head, and proximal radioulnar joint. The posterior global approach is recommended when the forearm synostosis is associated with complete bony ankylosis of the elbow involving the distal aspect of the humerus. After surgical resection of a proximal radioulnar synostosis, the exposed bone surfaces can be covered with interposition material to minimize recurrence.

Evaluation of optimizing Monteggia fracture-dislocation care: surgical innovations, radiological insights, and functional rehabilitation in adult patients

Background: Monteggia fractures, rare in adults, involve proximal ulna fracture and radial head dislocation. Managing these injuries poses challenges, fueling historical debates and driving advancements in internal fixation. Watson Jones' frustration highlights the ongoing pursuit of effective surgical approaches for optimal outcomes and functional limb restoration. his study aims to evaluate Monteggia fracture-dislocation treatment by analyzing radiological outcomes for structural insights and alignment post-surgery. Methods: This prospective observational study, conducted at Swapno general hospital, Mirpur-2, Dhaka, Bangladesh from 1st January 2021 to 31 January 2024, enrolled 30 patients with radiologically confirmed Monteggia fracture-dislocation. Surgical procedures involved creating an interval, anatomical reduction, and fixation, with regular follow-ups assessing outcomes, including range of motion, X-rays, and VAS scores, while statistical analysis utilized SPSS version 23. Results: The highest frequency percentage in the age distribution was observed among individuals aged 41-45, constituting 20% of the total sample, while the lowest frequencies were recorded in the 31-35 and &gt;51 age groups, each representing 10% of the sample. Physical assault emerged as the leading cause of injury, accounting for 40% of cases, followed by road traffic accidents at 36.66% and falls at 23.33%. In terms of final outcomes, the majority of patients (43.33%) achieved a good outcome, while the lowest percentage (10%) resulted in poor outcomes. Conclusions: In conclusion, addressing Monteggia fracture-dislocation in adults requires navigating inherent complexities. Modern internal fixation methods prove impactful, emphasizing the need for precise classification and stable anatomical reduction.

A Rare Case of Osteogenesis Imperfecta Type V

Osteogenesis imperfecta (OI) is a hereditary bone condition characterised by fragile bones to be more susceptible to fracture. We reported a rare case of a 6-year-old girl with OI Type V and hyperplastic callus formation. She presented with recurrent fractures since birth with no family history of a similar condition. Clinically, her height and weight were lower than the 5th percentile for her age. She had deformities with limitation of movement of elbows, kyphoscoliosis, a more extensive right thigh, and anterior bowing of both legs. Radiographic examination revealed interosseous membrane of forearm ossification, dislocation of the right radial head and hyper-callosity of both femurs during fracture healing. She was treated with intravenous pamidronate and had posterior instrumentation and fusion for scoliosis and intramedullary rodding for her femur fracture. On a recent follow-up at the age of 16 years, she was ambulating well with no progression of the spinal deformity.

Type I Monteggia Fracture with Associated Ipsilateral Capitellar and Humeral Diaphyseal Fractures in an Adult

Background: Monteggia fractures entail a proximal ulnar fracture with associated radial head dislocation. Primarily observed as a fracture in the pediatric population, there have been rare occurrences in adults. In rare instances, various associated fractures have been reported with Monteggia fractures. However, during our literature review, a type I Monteggia fracture had not been reported along with ipsilateral diaphyseal humerus and capitellar fractures. Here, we present a successful post-operative outcome for a unique fracture distribution and form of fixation that has yet to be reported in the literature.

Biomechanical simulation of radial head subluxation in cadaveric pediatric elbows

BackgroundRadial head subluxation, known as pulled elbow or nursemaid’s elbow, is a common pediatric condition that occurs when a longitudinal traction force is applied to an extended elbow. The purpose of our study was to demonstrate and quantify the axial traction force required to produce a nursemaid’s elbow in a pediatric cadaver specimen and to review the current relevant literature. MethodsWe performed a literature search to identify relevant articles describing the nursemaid’s elbow injury, as well as relevant biomechanical studies of the radiocapitellar joint. For the biomechanical model, 2 fresh-frozen cadaveric elbows from a single 3-year-old male donor were dissected by a fellowship-trained orthopedic surgeon. An Instron 5,944 testing machine with a 2 kN load cell was used to perform uniaxial testing. The radius and humerus were mounted to the Instron machine and loaded in the axial direction with the elbow in full extension. Loading occurred at a rate of 10 mm/second for 4 seconds, during which the force and actuator displacement were continuously recorded. The local instantaneous load and extension displacement at the time of subluxation were recorded. ResultsThe load to failure required to produce the nursemaid’s elbow injury in our first specimen was 31 N, with a failure displacement of 4.6 mm. The second specimen demonstrated a load to failure of 26 N, with a failure displacement of 4.6 mm. After subluxation, we reduced the annular ligament from the first specimen. The elbow was then retested and demonstrated a load to failure of 20 N, with a failure displacement of 2.6 mm. ConclusionsAxial traction applied to a pediatric elbow results in subluxation of the annular ligament into the radiocapitellar joint, at relatively low loads. We demonstrated a mean load to failure in a pediatric cadaveric model of 28.5 N, and a lower load to failure was required to produce a recurrent subluxation in a previously injured specimen. Key Concepts(1)Radial head subluxation, known as pulled elbow or nursemaid’s elbow, is a common pediatric condition that occurs when a longitudinal traction force is applied to an extended elbow.(2)This study is the first to demonstrate and quantify the axial traction force required to produce a nursemaid’s elbow in a pediatric cadaver specimen.(3)Axial traction applied to a pediatric cadaver specimen results in subluxation of the annular ligament into the radiocapitellar joint.(4)The mean load to failure is 28.5 N, and a lower load to failure is required to produce a recurrent subluxation in a previously injured specimen.(5)Literature supports that the nursemaid’s elbow injury is a result of subluxation of the annular ligament into the radiocapitellar joint, though this may involve a spectrum of injury to the annular ligament itself.

Acute Simple Elbow Dislocations in the United States: An Epidemiological Analysis of Trends Including COVID-19.

Background Elbows are one of the most frequently dislocated large joints; however, there is limited epidemiological data, especially during the coronavirus disease 2019 (COVID-19) pandemic. This study characterizes elbow dislocations presenting to Emergency Departments (EDs) over the last decade. Methods This study is a cross-sectional, descriptive, epidemiologic analysis of isolated elbow dislocations presenting to EDs from 2011-2020 using the National Electronic Injury Surveillance System (NEISS) database. Patients under 10, those with radial head subluxation, and those with complex fractures were excluded. Data on incidence ratios, patient demographics, mechanisms of injury, and incident locales were analyzed. Results Approximately 83,996 simple, primary elbow dislocations occurred from 2011-2020 (n=2,328), generating an incidence of 2.98/100,000 person-years. Incidence was higher among males (3.26 versus 2.69/100,000 person-years). Dislocations peaked in patients aged 10-19, with higher rates in males (11.12 versus 5.31/100,000 person-years; injury rate ratio 2.09, CI=2.05-2.14, p<0.001). Rates of elbow dislocations decreased with age in males (age 20-29=11.12, age >80=0.63/100,000) but increased in females over 40 (age 40-49=1.59, age 70-79=2.83/100,000). Athletic activities accounted for 55% of dislocations (n=45,902), with 15% from football and 14% from wrestling. The fewest annual dislocations occurred during COVID-19 (n=6440). Injuries occurring at schools and during contact and indoor sports decreased, while those from soccer increased. Conclusions Elbow dislocations are common, with trends of decreasing incidence with age among men and increasing incidence in women over 40. COVID-19 impacted sports-related and epidemiologic injury patterns. Ultimately, understanding population-level risks for elbow dislocations enables orthopaedic surgeons to predict injury trends and conceive educational preventative measures.

A Novel Operation Technique for Forearm Deformities in Patients with Brachial Plexus Birth Injury: Retrospective Analysis of 14 Patients.

Background: We aimed to evaluate the effectiveness of our novel operation technique that included radial shaft shortening plus supination producing osteotomy and transfer of the biceps brachii tendon to the brachialis tendon in patients with chronic radial head dislocation secondary to brachial plexus birth injury (BPBI). Methods: Fourteen patients with chronic radial head dislocation resulting from BPBI were included in this study, with a minimum 1-year postoperative follow-up period. All patients underwent the same surgical procedure. The range of motion of affected elbow was measured with a standard goniometer. The Mayo Elbow Performance Score (MEPS) was used to measure for evaluation of functional result of these patients. The affected elbow radiograph also obtained in the last visit for evaluation of compatibility of the radiocapitellar joint. Results: Fourteen patients (10 males and 4 females) were included in the study. The average age at the time of surgery was 7.2 (5-8) years and average follow-up was 73.2 ± 19 (36-131) months. Although the forearm active-passive pronation decreased, active-passive supination significantly improved postoperatively (p < 0.001). Ten patients had excellent MEPS results (90 and above), two patients with good results (75 and 80), one patient with fair (65) and one patient with poor result (55). Radiocapitellar reduction was achieved in 78.5% (11/14) of the patients. Conclusions: The novel surgical techniques that included radial shaft shortening plus supination producing osteotomy and transfer of the biceps brachii tendon to the brachialis tendon improved the functional outcomes of patients with chronic radial head dislocation secondary to BPBI. Level of Evidence: Level IV (Therapeutic).