Objective Improve the effectiveness of pediatric treatment of chronic radial head dislocations (CRHD). Material and methods The review included 100 pediatric patients aged 2–18 years treated for CRHD between 2005 and 2019. Patients underwent physical examination, radiological (conventional radiography, US, MRI, MSCT) evaluation and statistical analysis was performed. Patients were divided into two groups. A major group consisted of 33 (33%) patients who were treated with new bone and plasty procedures including open reduction of the radial head (ORRH), plasty of the annular ligament with m. anconeus flap and fixation with the plaster cast; osteotomy of the proximal ulna and ulnar realignment with the Ilizarov external fixation. Outcomes were retrospectively compared with 67 (67.0 %) control patients treated with different classical techniques including ORRH, radial head fixation with wires, polyethyleneterephthalate band or the remnants of the annular ligament, with/without ulnar osteotomy. Anatomical and functional results of treatment were evaluated at a short (up to one year) and long term (over one year) after frame removal using modified Mattis-Lyuboshitz-Shwarzberg grading scale. Results Comparative analysis of outcomes of surgical management at a short- and long term in both groups showed that the percentage of good results was 1.5 times higher in the major group. A table of differentiated indications to pediatric treatment of CRHD was devised based on the findings. Conclusion Biomechanical articular parameters appear to deteriorate over time following radial head dislocation and can result in radial head deformity, malaligned and shortened ulna. Pediatric treatment is supposed to be differentiated depending on time of injury, patient's age, anatomical and radiological manifestations of the joint. Operative pediatric treatment of CRHD involving bone and plasty procedures can provide good internal fixation preventing recurrence.

Abstract. Introduction Post-traumatic elbow contracture is a severe disabling condition of childhood that interferes with both physical and psychic aspects for the child. A high rate of poor results encourages surgeons seek for better surgical treatments. Current diagnostic modalities were practical to get the clinical picture of the contracture mechanogenesis and determine the treatment strategy. The goal of the study was to review long-term results of new surgical techniques developed for post-traumatic elbow contractures in children. Material and methods The inpatient records of 102 pediatric patients with post-traumatic elbow contractures operated on with the technique offered were reviewed. All patients underwent conventional radiological, ultrasound and MSCT examinations. Results Based on the pathobiomechanics of the injured elbow a mobilization technique was developed to ensure complete bone realignment, relieve pain and allow early exercises for the joint. Postoperative lavage of the joint cavity, intra-articular administration of corticosteroids and polyvalent enzymes in the early postoperative period facilitated improved long-term outcomes of elbow contractures. All patients reported good results. Discussion Tenotomies of the lateral ligaments can be added to arthrotomy and reconstruction of articular surfaces for temporary instability of the joint to restore movement in the elbow joint in severe cases. Post-traumatic elbow contractures are accompanied by impaired biomechanics. MSCT and 3D reconstruction of bone structures is the gold standard in the diagnosis of post-traumatic elbow contractures. Conclusion Bone impingements are to be addressed and an extended mobilization of the capsular ligamentous complex be provided for complete movement recovery through partial elbow instability to be temporarily ensured. Prolonged lavage of the elbow joint can be used to prevent adhesions and allow early elbow exercises and provide improved outcomes.