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Surgical treatment for chronic radial head dislocation.
Emiko Horii1, R Nakamura, S Koh
1Hand Division, Department of Orthopaedics, Nagoya University, Japan.
The Journal of Bone and Joint Surgery. American Volume
|July 11, 2002
Summary
Surgical correction of chronic radial head dislocation is challenging. Modified ulnar osteotomy techniques improve reduction rates and minimize complications, offering a better surgical outcome for patients.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Chronic radial head dislocation treatment is controversial due to high redislocation and complication rates.
- Surgical correction of malalignment via ulnar osteotomy is proposed as crucial for successful outcomes.
- Previous surgical methods had limited success in achieving stable reduction.
Observation:
- Twenty-two patients with chronic radial head dislocation underwent surgical treatment between 1975 and 1991.
- A modified oblique ulnar osteotomy with angulation, elongation, and rigid plate fixation was introduced in 1991.
- Nine patients were treated with the modified technique, with bone grafting performed as needed.
Findings:
- The modified ulnar osteotomy technique resulted in a 78% good reduction rate (7 out of 9 patients).
- Pre-1991 treatments showed a lower good reduction rate (4 out of 13 patients) with a high redislocation rate (7 patients).
- Postoperative restricted forearm rotation was observed in both groups but appeared less frequent with the modified technique.
Implications:
- Modified ulnar osteotomy, incorporating both angulation and elongation, is essential for successful radial head reduction.
- This technique appears to reduce the incidence of redislocation and severe complications.
- The findings suggest a more reliable surgical approach for chronic radial head dislocations, particularly in pediatric patients.