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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.
Journal of Pediatric Orthopedics
|February 27, 2003
Summary
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.