Radial Neck Osteotomy for Malunion Correction in the Pediatric and Adolescent Population

Radial head and neck fractures can be difficult to diagnose acutely in the pediatric and adolescent population, especially when radiographic findings are subtle. Visualization of fracture displacement and incongruency of the radiocapitellar joint is highly dependent on ossification of the radial head and arm positioning, leading to missed or inaccurate diagnoses. If these fractures heal with joint subluxation/dislocation or in a position that leads to pain, loss of motion, or functional limitations, corrective osteotomy of the radial neck may be indicated. The goal of radial neck osteotomy is a stable and congruent radiocapitellar joint that provides full elbow and forearm motion. Radial neck osteotomy is challenging given concerns for healing without mechanical impingement, the proximity of critical neurovascular structures, avascular necrosis, and physeal arrest. In addition to restoring alignment, reconstructive surgery should address deficient ligamentous anatomy if necessary to address subluxation of the radiocapitellar joint. We present our surgical technique and case examples of radial neck osteotomy and lateral ulnar collateral ligament advancement for chronic injuries in the pediatric population.