Burnei's technique in the treatment of radial head displacement; innovative surgery. Study on two cases

Dislocation of the radial head, congenital or traumatic, anteriorly, posteriorly or laterally displaced, requires surgery to reseat and stabilize the head of the radius within the joint, in order to restore elbow flexion and, as much as possible, pronation-supination.

This article is meant to present the technique of proximal radial-ulnar ligament plasty using the extensor carpi radialis longus (ECRL) tendon, as well as other techniques for the stabilization of a dislocated radial head. The ECRL tendon technique, quadrate and annular ligament reconstruction variant was first used by Gh. Burnei in 1985, at Mangalia Municipal Hospital, Romania.

This study contains two clinical cases, a 6-year-old girl with congenital dislocation of the radial head, and a 10-year-old boy with traumatic dislocation of the radial head, both of whom were treated by open reduction and stabilization of the dislocation with the ECRL tendon, using the Burnei procedure.

In both cases, the operation was successful in the reduction and stabilization of the dislocated radial head, whose position was maintained in flexion-extension and pronation-supination, and in the reconstruction of the annular ligament using Burnei's procedure, variant 2. Postoperatively, the clinical evolution was good, the patients having regained elbow mobility. The child with congenital dislocation exhibits normal flexion and pronation-supination within normal range, and the traumatic dislocation also exhibits normal flexion and pronation-supination limited with 20 degrees. Radiologically, in both cases the radial head is anatomically placed relatively to the humeral capitellum, in both flexion and extension.

Stabilization of the radial head in traumatic or congenital dislocation can only be surgically achieved. Congenital dislocation of the radial head requires the reconstruction of the proximal radial-ulnar joint, preferably at a young age, in order to avoid subsequent complications, culminating in ulnar or radial nerve paralysis. Traumatic dislocation of the radial head is usually accompanied by the fracture of the ulna, but may be encountered in isolation.

The Burnei procedure is an alternative for the treatment of radial head dislocation and is advantageous because of the use of a study, well vascularized tendon, which allows, when needed, the complete reconstruction of the proximal radial-ulnar ligaments, or just the annular ligament, in order to stabilize the head of the radius within the elbow joint. Also, the technique doesn't require osteotomies or an osteosynthesis requiring another surgery to remove the synthesis materials.