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Published on: January 11, 2016
Radial head dislocation in children with cerebral palsy
A Kareem Abu-Sneineh1, Peter G Gabos, Freeman Miller
1Alfred I. duPunt Hospital for Children, Wilmington, Delaware 19899, USA.
Insights
Radial head dislocation in children with cerebral palsy (CP) is rare. Excision of the radial head offers better outcomes than reconstructive surgery for painful dislocations in CP patients.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Research
Background:
- Radial head dislocation is an uncommon injury, particularly in children with cerebral palsy (CP).
- The optimal surgical management for symptomatic radial head dislocation in CP remains unclear.
Observation:
- This study reviewed 10 painful radial head dislocations in 8 children with spastic quadriplegic-pattern CP over 21 years.
- Four patients underwent open reduction and annular ligament reconstruction; four underwent radial head excision with early motion.
Findings:
- Reconstructive surgery resulted in redislocation within 16 weeks, with recurrent pain and elbow contracture.
- Radial head excision led to pain-free outcomes and improved elbow motion in all four patients, with a mean follow-up of 4 years 4 months.
Implications:
- Radial head excision appears to be a more effective treatment for established, symptomatic radial head dislocations in children with CP.
- These findings suggest a paradigm shift in surgical decision-making for this specific patient population.
Abstract:
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.
