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The Journal of Bone and Joint Surgery (American) 84:1183-1188 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Surgical Treatment for Chronic Radial Head Dislocation

Emiko Horii, MD, R. Nakamura, MD, S. Koh, MD, H. Inagaki, MD, H. Yajima, MD and E. Nakao, MD

Investigation performed at the Hand Division, Department of Orthopedics, Nagoya University, Nagoya, Japan

Emiko Horii, MD
R. Nakamura, MD
S. Koh, MD
H. Inagaki, MD
H. Yajima, MD
E. Nakao, MD
Hand Division, Department of Orthopedics, Nagoya University, 65 Tsuruma, Showa-ku, Nagoya 466-8550, Japan

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background : The treatment of chronic radial head dislocation remains controversial. High rates of redislocation and complications have been reported after surgery. In our view, correction of malalignment with ulnar osteotomy is the key to a good surgical result.

Methods: Since 1975, twenty-two patients were treated surgically for chronic radial head dislocation at our hospital. The procedure consisted of open reduction of a dislocated radial head followed by radial and/or ulnar osteotomy, with or without reconstruction of the annular ligament or by reconstruction of the annular ligament alone. The ages of the patients ranged from four to twenty years. In 1991, we modified the surgical technique by performing an oblique ulnar osteotomy with angulation and elongation and rigid plate fixation. Bone-grafting at the osteotomy site was also performed if necessary. A cast was applied with the forearm in neutral rotation and was worn for two to four weeks. Nine patients were treated with this modified technique.

Results: The mean interval between the initial injury and the reconstructive surgery was ten months. There were no serious surgical complications. Of the thirteen patients treated before 1991, four had a good reduction and seven had redislocation. Seven patients had restricted forearm rotation postoperatively. Of the nine patients treated with the modified osteotomy since 1991, seven had a good reduction. Two patients, who had had slight radial head deformity preoperatively, had subluxation postoperatively. Two patients had restricted forearm rotation.

Conclusions: Since we modified our technique for ulnar osteotomy, good reduction of the radial head has been achieved without causing serious contracture. Both angulation and elongation of the ulna are required to allow the radial head to reduce.


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