Radial Head In Children Research Articles

Outcome following excision of the radial head in children with open physes for impaired elbow motion

Only few reports have described the outcome of pediatric patients following radial head resection. Therefore, the aim of the present study was to assess clinical and radiologic outcome of patients with open physes following resection of the radial head. Skeletally immature patients treated with resection of the radial head were included. Range of motion (ROM) of the elbow joint was compared with preoperative values. Grip strength, pronation and supination strength, and carrier angle were compared with the unaffected side. Radiographs were assessed for signs of arthrosis, radial migration, and perifocal ossification. Disabilities of the Arm, Shoulder and Hand and Mayo Elbow Performance scores were obtained. The study included 7 patients (mean age, 11 years), 5 with post-traumatic and 2 with congenitally impaired elbow joint motion. Mean follow-up was 47 months. Pronation/supination ROM improved significantly (P = .018). Extension/flexion ROM did not improve significantly (P = .122). Although grip strength (P = .027) and pronation strength (P = .028) of the affected side were significantly lower compared with the contralateral side, supination strength did not differ significantly (P = .176). The carrying angle was increased in 3 patients. Significant radial migration occurred (mean, 3 mm; standard deviation [SD], 3 mm; P = .018). Arthrosis was found in 3 patients. The mean Disabilities of the Arm, Shoulder and Hand score was 16.1 (range 8.8-30.8; SD, 10.1) and mean Mayo Elbow Performance Score was 88 (range, 70-100; SD, 12). Radial head excision may be considered for selected patients with open physes in cases of severe impairment of pronation/supination. However, sequelae such as radial migration, arthrosis, and elevation of the carrying angle should be expected.

Posterior interosseous nerve entrapment after Monteggia fracture-dislocation in children

ObjectiveAlthough most of nerve injuries associated with Monteggia fracture-dislocation in children are neurapraxias and will recover spontaneously after conservative treatment, surgical exploration of the involved nerve is always required in the cases with the entrapment of posterior interosseous nerve (PIN). However, the necessity and time frame for surgical intervention for specific patterns of nerve dysfunction remains controversial. The aim of the report is to observe and understand the pathology of PIN injury associated with Monteggia fracture-dislocation in children, and to propose the possible indication for the exploration of nerve MethodsEight cases, six boys and two girls, with Monteggia fracture-dislocation complicated by PIN injury, managed operatively at the authors’ Hospital from 2007 to 2008 were retrospectively reviewed. All the patients underwent the attempted closed reduction before they received exploration of PIN, with open reduction and internal fixation or successful closed reduction. ResultsThe PIN was found to be trapped acutely posterior to the radiocapitellar joint in 4 out of 5 Type III Bado’s Monteggia fractures. In the remaining cases, since there were longer time intervals from injury to operation, chronic compressive changes and epineural fibrosis of radial nerve were visualized. After a microsurgical neurolysis performed, the complete recovery in the nerve function was obtained in all the cases during the follow-up. ConclusionThe findings from this study suggest that every case of type III Monteggia fracture-dislocation with decreased or absent function of muscles innervated by PIN and an irreducible radial head in children should be viewed as an indication for immediate surgical exploration of the involved nerve to exclude a potential PIN entrapment.

Re-dislocation after corrective osteotomy for chronic dislocation of the radial head in children.

This retrospective study was designed to evaluate the outcomes of re-dislocation of the radial head after corrective osteotomy for chronic dislocation. A total of 12 children with a mean age of 11 years (5 to 16), with further dislocation of the radial head after corrective osteotomy of the forearm, were followed for a mean of five years (2 to 10). Re-operations were performed for radial head re-dislocation in six children, while the other six did not undergo re-operation ('non-re-operation group'). The active range of movement (ROM) of their elbows was evaluated before and after the first operation, and at the most recent follow-up. In the re-operation group, there were significant decreases in extension, pronation, and supination when comparing the ROM following the corrective osteotomy and following re-operation (p < 0.05). The children who had not undergone re-operation achieved a better ROM than those who had undergone re-operation. There was a significant difference in mean pronation (76° vs 0°) between the non- re-operation and the re-operation group (p = 0.002), and a trend towards increases in mean flexion (133° vs 111°), extension (0° vs 23°), and supination (62° vs 29°). We did not find a clear benefit for re-operation in children with a re-dislocation following corrective osteotomy for chronic dislocation of the radial head.

Fractures of the radial head in children: about 66 cases

Les fractures de la tête radiale sont des fractures rares, en effet elles représentent 1% des fractures de l'enfant, mais elles restent graves par leurs complications qui sont dominés par les troubles de croissance et surtout la nécrose de la tête radiale. Nous avons pu analyser 66 dossiers chez des enfants âgés de 4 à 14 ans, étude colligée au Service de Traumato-Orthopédie Pédiatrique du CHU Hassan II de Fès, sur une période de 6 ans. l'âge moyen était de 9,4ans. Les fractures stade I et II représente 77.28%. Le traitement orthopédique a été réalisé dans 45 cas. Le traitement chirurgical a été indiqué en 2éme intention chez 21 malades, dont 9 malades ont bénéficié d'une réduction sanglante. L'étude clinique reste pauvre, la radiologie occupe une place prépondérante dans le diagnostic positif et pour l'orientation thérapeutique. Les méthodes sont variables, l'indication et le résultat dépendent du degré du déplacement.

Indirect Reduction of the Radial Head in Children With Chronic Monteggia Lesions

Indirect Reduction of the Radial Head in Children With Chronic Monteggia Lesions

Indirect Reduction of the Radial Head in Children With Chronic Monteggia Lesions

The purpose of this study was to report the long-term follow-up results of chronic Monteggia fractures treated with angulation-translation osteotomy of ulna and closed reduction of the radial head. Retrospective. Level 1 trauma center. We retrospectively reviewed 10 missed Monteggia fractures in children. The mean age of the patients was 7.5 years (range, 6-10 years), and there were 2 girls and 8 boys. The mean duration of time between initial injury and initial presentation was 1.7 years (range, 6 weeks to 5 years). Closed reduction with ulna osteotomy or lengthening was performed in all 10 cases. Annular ligament reconstruction (ALR) was done in 2 cases. Final follow-up ranged from 3 to 20 years (mean 10 years). We assessed preoperative and postoperative radiographs to evaluate the quality of the radial head reduction. Clinical results were assessed according to the functional elbow score devised by Kim et al. Radial head reduction was achieved and maintained in 8 of 10 cases after primary or secondary surgery. The radial head was mildly subluxated in one case and dislocated in another case at final follow-up. ALR was performed in only 2 cases. Open reduction and ALR is not required in every case, and its need should depend on intraoperative stability of radial head.

Rare Cause of Block to Reduction After Radial Head Dislocation in Children

This case report documents a rare cause of block to reduction in association with an anterior traumatic dislocation of the radial head in children. The radial head dislocations described were not reducible with a closed reduction secondary to "button holing" of the radial head through the anterior joint capsule. Open reduction was required to release the capsule and reduce the radial head. After reduction, the elbow was immobilized in flexion and the forearm in mild supination for 3 weeks. Postoperatively, all patients demonstrated full elbow function and range of function.

Luxation latérale invétérée post-traumatique de la tête radiale

Chronic dislocation of the radial head in children due to undiagnosed Monteggia's lesion is uncommon. Although it can initially be asymptomatic pain, restriction of movement and secondary arthritic changes may develop as the child grows. The treatment of chronic radial head dislocation remains controversial varying from benign neglect to surgical reduction. Only five chronic lateral Monteggia's lesions have been described with variable surgical results associated with redislocation. A case of chronic post-traumatic lateral dislocation of the radial head in a child treated with ulna osteotomy rigidly fixed and reattachment of the annular ligament is presented. At 2 years follow-up, the clinical result was very satisfying and concentric reduction was maintained. The authors conclude this may be an effective procedure for chronic post-traumatic lateral dislocation of the radial head in children.

Chronic post-traumatic lateral dislocation of the radial head

Chronic dislocation of the radial head in children due to undiagnosed Monteggia's lesion is uncommon. Although it can initially be asymptomatic pain, restriction of movement and secondary arthritic changes may develop as the child grows. The treatment of chronic radial head dislocation remains controversial varying from benign neglect to surgical reduction. Only five chronic lateral Monteggia's lesions have been described with variable surgical results associated with redislocation. A case of chronic post-traumatic lateral dislocation of the radial head in a child treated with ulna osteotomy rigidly fixed and reattachment of the annular ligament is presented. At 2 years follow-up, the clinical result was very satisfying and concentric reduction was maintained. The authors conclude this may be an effective procedure for chronic post-traumatic lateral dislocation of the radial head in children.

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

Radial Head Dislocation in Children With Cerebral Palsy

Dislocation of the radial head in children with cerebral palsy (CP) is rarely reported, and the incidence of the condition is unknown. The authors present the treatment and outcome of 10 painful radial head dislocations in eight children with spastic quadriplegic-pattern CP treated over a 21-year period. Four patients were managed by open reduction of the radial head and reconstruction of the annular ligament, and four were managed by radial head excision followed by early motion. All of the patients who underwent reconstructive surgery suffered redislocation within 16 weeks of the procedure, with a return of pain and contracture of the elbow at subsequent follow-up. All four patients who underwent excision of the radial head remained pain-free, with improved elbow motion, at a follow-up of 4 years 4 months. The authors believe that once symptomatic radial head dislocation is established in CP patients, excision of the radial head gives a better final outcome than reconstructive procedures.

Avascular Necrosis of the Radial Head in Children

Avascular necrosis of the radial head is uncommon. A 20-year review of records at a Pediatric Trauma Center revealed eight cases of avascular necrosis of the radial head in children with an average of 10 years (range, 7-16 years). Symptoms of pain or restriction of elbow motion began at an average of 23 months after trauma in seven cases, and in one case, there was no history of trauma. Of the seven secondary to trauma, six resulted from a fall, and one from a torsional injury. The types of injuries associated with avascular necrosis of the radial head were two supracondylar fractures, a fracture of the lateral condyle, two fractures of the radius, a radial head dislocation that underwent a proximal radial osteotomy, and one with only an elbow contusion. The long-term results of radial head necrosis were poor, with three ultimately requiring radial head resection, and the remainder having considerable limitation of elbow motion. Loss of vascularity to the radial head is very analogous to avascular necrosis of the femoral head, with the late onset of incongruity, osteoarthritis, and hypertrophy of the head. It should be considered in any child with late-onset loss of elbow motion after trauma.

Isolierte traumatische Speichenköpfchenluxation im Kindesalter

Isolated dislocations of the radial head in children without fracture of the ulna are an extremely rare injury. The diagnosis is easily missed. This leads to permanent deformity of the elbow; on the other hand prompt treatment restores a normal anatomical and functional elbow. Fourteen patients and their long-term outcome are presented.

Fracture of the shaft of the radius and dislocation of the ipsilateral radial head in children: beware of rare injuries

Fracture of the shaft of the radius and dislocation of the ipsilateral radial head in children: beware of rare injuries

Old unreduced dislocation of the radial head in children

Old unreduced dislocation of the radial head in children

Treatment of chronic post-traumatic dislocation of the radial head in children.

Seven children with chronic post-traumatic dislocation of the radial head were treated by open reduction and ligament reconstruction by a triceps tendon slip. In the four patients with anterior dislocation, good results were achieved; in the two with anterolateral dislocations bowing of the ulna persisted and subluxation recurred. One patient with an anterior dislocation developed a radio-ulnar synostosis. For anterolateral dislocations, we advise the combining of open reduction and ligament reconstruction with osteotomy of the ulna.

Isolated dislocation of the radial head: a report of two cases

Two cases of isolated dislocation of the radial head in children are presented. The clinical presentation, radiographic appearances, management and prognosis are discussed, and a brief literature review is presented.

Radial head dislocation : Hudson D. A. and de Beer J. de V. (1986) Isolated traumatic dislocation of the radial head in children. J. Bone Joint Surg.68B, 378

Isolated radial head dislocation is uncommon. It most commonly presents as a partial dislocation or subluxation, also known as nursemaid’s elbow, seen in children. Complete radial head dislocation, although rare, is most commonly associated with high force injuries of the arm, and therefore are often associated with a forearm fracture or dislocation. A thorough history, physical exam, along with imaging, can aid in the appropriate evaluation and decrease the chances of complications by missed diagnosis. Although the reduction procedure is generally a straightforward process for radial head subluxation, a missed or neglected radial head dislocation will need surgical repair due to their association with ulnar fractures and other complications.

Isolated traumatic dislocation of the radial head in children.

Isolated traumatic dislocation of the radial head in children is not as rare as sometimes supposed. Attention to detail in radiographic interpretation is the key to diagnosis. Early closed reduction and immobilisation in an above-elbow plaster in 90 degrees of flexion and full supination for three to six weeks is recommended. Seven cases are presented, two of which were treated operatively and had unsatisfactory results. The applied anatomy, management and complications are discussed.

Anterior dislocation of the radial head in children: aetiology, natural history and management

The results of operation for traumatic anterior dislocation of the head of the radius in eight children have been reviewed. We are satisfied on the basis of the results obtained and the outcome in one untreated patient that operative reduction is fully justified, provided that the annular ligament is reconstructed and internal fixation employed. We have not seen unilateral congenital dislocation and doubt its existence. Secondary subluxation of the distal radio-ulnar joint has been noted in an untreated patient.