Bell-Tawse procedure with cortical fixation using endo-button in anterior radial head dislocation: A case report

Anterior radial head dislocations are rare in adults. Misdiagnosis to Monteggia fracture-dislocation can occur up to 28 %, which results in failed detection of the misaligned radiocapitellar joint. Anterior radial head dislocation is treatable using the Bell Tawse technique. However, reports regarding the technique are rare in adults, with no endo-button use.

A 26-year-old male came to the orthopedic outpatient clinic with left elbow pain as his chief complaint. The affected hand was a non-dominant hand. The patient had a work-related injury where the fractures were already immediately treated with open reduction internal fixation (ORIF) 4 months prior. Radiograph images showed anterior radial head dislocation with internally fixated distal-third humerus and proximal-third ulnar fractures. The patient was diagnosed with recurrent radial head dislocation post-Monteggia facture. The patient underwent Bell Tawse with cortical fixation using an endo-button.

After 1 year, the patient felt no more pain (visual analog scale (VAS) score 0). The patient was satisfied with the one-year outcome with improved elbow function. The American Shoulder and Elbow Surgeons (ASES) score and the disabilities of the arm, shoulder, and hand (DASH) score improved.

Endo-button hadn't been used in annular ligament reconstruction, especially the Bell Tawse procedure. In our report, we used endo-button cortical fixation to compensate for the inadequate graft length in an adult case. At the one-year follow-up, the patient had no complaints of pain and could do normal activities.