A salvage procedure: Radial head excision in children and adolescents—short-to-midterm outcomes and overview of the literature

Abstract

Purpose: Purpose of the study was to report the outcomes after radial head excision in children and adolescents in addition with a review of the current literature. Methods: We report a series of five children and adolescents, who had undergone a post-traumatic radial head excision. Clinical outcomes were evaluated in terms of elbow/wrist range of motion, stability, deformity and discomforts or restrictions at two follow-up points. Radiographic changes were evaluated. Results: Patient’s age at time of the radial head excision averaged 14.6 (13–16) years. Mean time from the injury to the radial head excision was 3.6 (0–9) years. Follow-up I averaged 4.4 (1–8) years and follow-up II 8.5 (7–10) years. At follow-up I, patients showed an average elbow range of motion of 0-10-120° Ext/Flex and 90-0-80° Pro/Sup. Two patients reported discomfort or pain at the elbow. Four (80%) patients had a symptomatic wrist with pain or crepitation at the distal radio ulnar joint. In three (60%) of them, an ulna plus at the wrist was present. Two patients required ulna shortening and autograft stabilization of the interosseous membrane. At final follow-up, all patients reported full functioning with daily activities. Restrictions were present with sport activities. Conclusion: Functional results at the elbow joint might be improved and pain syndromes lessen due to the radial head excision. Problems at the wrist are likely secondary to the procedure. A critical analysis of other options should be performed ahead of the procedure and a careless application should be avoided by all means. Level of evidence: IV

Missed Monteggia Injuries in Children and Adolescents: A Treatment Algorithm

“…The authors recommend immobilization in a plaster cast 2 weeks after surgery, followed by a motion orthosis (ROM: Ex/Flex: 0-20-120 • ) for a further 4 weeks. Due to the occurrence of proximal migration of the radius (3.4-5.4 mm after 7-10 years) [52,54], perifocal ossification and recurrent synostosis [52], reformation of the radial head [64], as well as cubitus valgus and instability [51,53,56], repeated revision surgery may be required, which is why radial head excision is only recommended in the pediatric population shortly before or after skeletal maturity (Table 1).…”