[Treatment of old radial head dislocation in children]

Taozhen He, Xiaoyan Sun, Jun Jiang, Mingxing Peng, Huixu Ma, Lixun Yang, Bin Xiao, Min Liu
Chinese Journal of Reparative and Reconstructive Surgery 2014, 28 (8): 929-32

OBJECTIVE: To evaluate the short-term effectiveness of transarticular fixation of humeroradial joint by Kirschner wire (or combined with proximal ulnar osteotomy) for old radial head dislocation after open reduction of the radial head in children.

METHODS: A retrospective analysis was made on the clinical data of 25 children with old radial head dislocation between January 2008 and December 2010. There were 18 boys and 7 girls, aged 2 years and 5 months to 9 years and 5 months (mean, 5 years and 11 months). The left side was involved in 13 cases, and the right side in 12 cases. The interval of injury and operation was 3 weeks to 30 months (median, 14 months). The main presentations were abnormal mass in the anterior elbow, motion limitation of forearm pronation, and dorsiflexion inability of wrist and thumb. Three patients had radial nerve lesion. In 23 patients with simple radial head dislocation, transarticular fixation of humeroradial joint by Kirschner wire was used after open reduction of the radial head; in 2 patients with Monteggia fracture, transarticular fixation by Kirschner wire and additional proximal ulnar osteostomy were used.

RESULTS: A primary healing of incision was obtained, without complication of infection, joint stiffness, or radial head necrosis. Twenty-four patients were followed up 29-58 months (mean, 44.3 months); one case had re-dislocation, failed to be followed up at 2.5 months postoperatively. In 3 patients with radial nerve injury, neural function recovery was obtained in 2 cases, and no improvement was observed in 1 case. Twenty-three had no pain, no deformity, and no motion limitation of elbow and forearm except 1 patient with no improvement of neural function. The mean range of montion (ROM) of elbow flexion was 134 degrees (range, 125 - 140 degrees), and the mean ROM of extension was -4 degrees (range, - 8-0 degrees); the mean ROM of forearm pronation was 74 degrees (range, 65-80 degrees ), and the ROM of supination was 90 degrees. According to Mackay's criteria, the results were excellent in 22 cases, good in 1 case, and poor in 1 case at 2 years after operation.

CONCLUSION: The transarticular fixation of humeroradial joint by Kirschner wire (or combined with proximal ulnar osteotomy) is a feasible and effective method to treat old radial head dislocation in children based on a short-term follow-up.

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