Delayed dislocation of the radial head associated with malunion of distal radial fracture: A case report

BACKGROUND Traumatic radial head dislocation(RHD)is a well-described injury in the pediatric population.It is usually associated with an injury to the ulna in Monteggia fracture-dislocation,although it can occur as an isolated injury.Traumatic RHD with ipsilateral radial shaft fracture has rarely been reported.Delayed RHD secondary to the malunion of an isolated radial shaft fracture is extremely rare.CASE SUMMARY We report a 9-year-old boy with limited pronation of the right elbow.The patient was diagnosed with delayed RHD associated with the malunion of a distal radial fracture.Since the annular ligament was disrupted with forearm rotation causing subluxation of the radial head,a modified double-strip Bell Tawse procedure was performed to reconstruct the annular ligament without corrective osteotomy for the malunited site.Four years after surgery,the angulation deformity of the distal radius was corrected with the restoration of the normal curvature of the radius.There was no recurrence of RHD.CONCLUSION Annular ligament reconstruction without corrective osteotomy could reduce RHD and restore the normal curve of the radial shaft in children with delayed dislocation of the radial head associated with malunion of the radial shaft.Annular reconstruction using double triceps tendon strips might be useful for maintaining a more stable reduction by augmenting anterolateral parts.

Radial Head Dislocation Associated with an Ipsilateral Open Type II Gustilo-Anderson Fracture of the Radial Shaft

Radial head dislocation associated with an ipsilateral radial shaft fracture is a rare lesion, even more so for open lesions. Few cases have been found in the literature. We report this case due to its exceptional nature and discuss the mechanism of onset. A twenty-five-year-old patient presented with a dislocation of the radial head associated with a GUSTILO ANDERSON type II open fracture of the radial shaft following an occupational accident. He was managed twenty-four hours after the trauma. The mechanism was a direct blow. The dislocation was reduced by external manoeuvre following open reduction of the radial shaft. The fracture was stabilized by two Kirschner wires following reduction. The result at 12 months was satisfactory from a clinical and radiological standpoint.

Open reduction and internal fixation for radial head fractures: A prospective observational study

Objective: To evaluate the effect of open reduction and internal fixation on radial head fracture and assess the post-operative function. Methods: This prospective observational study was conducted from June 2016 to July 2017 at Liaquat National Hospital and Medical College, Karachi. Altogether, 28 patients with radial head and neck fractures were enrolled in our study. These patients were admitted to the hospital and their fractures were fixed with open reduction and internal fixation. Baseline information of the patients was collected, and patient-rated elbow evaluation scores were calculated. Results: Out of the 28 patients, 21 were male and 7 were female. Besides, 16 fractures were on the right side and 12 were on the left side and 17 involving the dominant hands. In addition, 8 patients had Mason type Ⅱ fracture and 20 had Mason type Ⅲ fracture. The mean age of patients was (31.0 ± 8.0) years, and the mean follow-up is (1.2 ± 0.5) years. The mean average patient-rated elbow evaluation scores were (27.64 ± 1.60) at 1-year follow-up. Conclusions:The majority of the patients who had radial head fractures and treated by open reduction and internal fixation have attained an excellent range of motion postoperatively.

Diagnosis,treatment and complications of radial head and neck fractures in the pediatric patient

Radial head and neck fractures represent up to 14%of all pediatric elbow fractures and can be a difficult challenge in the pediatric patient.In up to 39%of proximal radius fractures,there is a concomitant fracture,which can easily be overlooked on the initial standard radiographs.The treatment options for proximal radius fractures in children range from non-surgical treatment,such as immobilization alone and closed reduction followed by immobilization,to more invasive options,including closed reduction with percutaneous pinning and open reduction with internal fixation.The choice of treatment depends on the degree of angulation and displacement of the fracture and the age of the patient;an angulation of less than 30 degrees and translation of less than 50%is generally accepted,whereas a higher degree of displacement is considered an indication for surgical intervention.Fractures with limited displacement and non-surgical treatment generally result in superior outcomes in terms of patient-reported outcome measures,range of motion and complications compared to severely displaced fractures requiring surgical intervention.With proper management,good to excellent results are achieved in most cases,and long-term sequelae are rare.However,severe complications do occur,including radio-ulnar synostosis,osteonecrosis,rotational impairment,and premature physeal closure with a malformation of the radial head as a result,especially after more invasive procedures.Adequate follow-up is therefore warranted.

The Early Outcomes with Titanium Radial Head Implants in the Treatment of Radial Head Comminuted Fractures

The study assessed the early functional outcomes with cemented titanium implants of radius in the treatment of comminuted fractures of radial heads. The functional outcomes of arthro- plasty with cemented titanium implants of radius in the treatment of radial head fractures （Mason Type Ⅲ： 6; Mason Type Ⅳ： 4） in l0 consecutive patients （mean age, 38 years） were evaluated over a mean time of 23.7 months （18-31 months）. The patients were assessed on the basis of physical examination, functional rating （Mayo） and radiographic findings. The parameters evaluated included motion, stability, pain, and grip strength. Five patients were considered to have excellent results, 4 patients had good results and l patient had fairly good results. There were no cases of infection, prosthetic failure, heterotopic ossification or dislocation. When medial collateral ligament was injured, radial head became the main stabilizing structure of the elbow. Titanium radial head implant may provide the stability similar to that of native radial head. We believe that titanium radial head im- plants may be indicated for the Mason Type Ⅲ and Mason Type IV radial head fractures.

Traumatic Isolated Radial Head Dislocation in Children: A Case Report

The isolated dislocation of the radial head is frequently described in the lesion of MONTEGGIA. However it can be a rare isolated pattern of injury in children. Only 81 cases were reported in the literature to our knowledge. The case we report concerns a 13 years old boy, examined 8 days after injury. Because of failure of manual reduction, we performed a surgical management with excellent results after a year of follow-up. We have discussed treatment option and the results obtained.

Fracture of proximal radius combined with dislocation of the radial head:a case report

Forearm fractures are prevalent which include radius fractures,ulna fractures,or both radius and ulna fractures.Proximal radius fractures combined with dislocations of the radial heads are rare and easily misdiagnosed.The authors present and discuss a case of proximal radius fractures associated with radial head dislocations.A 36 years old male was admitted to the hospital due to pain and activity limitation in his left elbow for 7 hours due to a car accident.An X-ray of the left elbow joint revealed a“left radius fracture with surrounding soft tissue edema”.During the procedure,the radial head was found to be dislocated forward.A 3.0 mm anchor was used to fix the annular ligament.Radius fractures combined dislocations of the radial heads are rare and may be missing the diagnosis.Before undergoing surgery,the possibility of elbow dislocation should be evaluated.Wire anchors can provide reliable fixation.

Irreducible anteromedial radial head dislocation without fracture caused by transposed biceps tendon in an adult:A case report and literature review

Irreducible anteromedial radial head dislocation(IARHD)caused by transposed biceps tendon is rare.Delayed diagnosis and surgical failure often occur.A 46-year-old fisherman presented with 10 days history of painful swelling and restricted movement of his right elbow due to strangulation injury by a fishing boat cable.On examination,the images of the right elbow reveals in a"semi-extended and pronated"elastic fixation position.Radiography and 3-dimensional reconstruction CT reveals an isolated anteromedial radial head dislocation with extreme protonation of the radius and the bicipital tuberosity towards the posterior aspect of the elbow joint,and MRI shows biceps tendon wrapping around the radial neck,similar to umbilical cord wrapping seen in newborns.The Henry approach was applied for the first time to reduce the biceps tendon.The patient achieved a good functional recovery at 26 months,which represents the first reported case of IARHD without fracture caused by biceps tendon in an adult.In treatment of IARHD,attention should be paid to the phenomenon of biceps tendon transposition.Careful clinical examination,comprehensive imaging modalities,and appropriate surgical approach are the keys to successful management.

Radial head subluxation in pediatric clinics and emergency departments in China

Purpose:To investigate the characteristics of the onset and treatment of radial head subluxation(RHS)in pediatric clinics and emergency departments.Methods:A retrospective study was performed on 11,404 RHS cases in 9827 children who visited pediatric clinics and emergency departments from January 2015 to December 2018.The patients who with history of trauma and fracture of the affected limb were excluded.The following factors were examined:the mechanisms of RHS,the type of manual reduction,the attending physician's clinical background(emergency surgeon,junior pediatric orthopedic surgeon or senior pediatric orthopedic surgeon),and the epidemiological features(gender,age,climate and location)of the injury.Results:The mean age of the patients was 27.93±17.94 months(range 0.93-214.53 months),with a peak incidence of 10.73-44.53 months.Approximately two-thirds of RHS cases occurred in cold weather from January to March and from September to December.Females accounted for 53.81%(n=6137)of the cases,and left injuries were predominant(56.87%,n=6485)in all cases.Mechanisms of injury were classified as"pull"(90.57%,n=10,339),"fall"(1.56%,n=178),"hit"(0.75%,n=86)and"unknown"(7.02%,n=801).The overall success rate of manual reduction was 99.47%,and the success rate of reduction was higher for senior pediatric orthopedic surgeons than for emergency surgeons and junior pediatric orthopedic surgeons(p<0.05).However,there was still a recurrence rate of 12.16%in the 9827 patients.Conclusion:Younger children are predisposed to RHS,and there is a possibility of recurrence.Trained emergency doctors can handle it well,but it is essential to refer patients to specialists when manual reduction failed.