Irreducible Anteromedial Dislocation of Radial Head with Biceps Tendon Interposition

Abstract

The case presents an isolated irreducible anteromedial dislocation of radial head due to biceps tendon interposition on a 14-year-old female patient. After an unsuccessful closed reduction, a lateral approach of the left elbow was carried out through Kocher's interval. Given that no pathology was found on the radiohumeral joint, the approach was extended distally. This revealed that the biceps tendon was displaced laterally around the radial neck, preventing the reduction. Once the tendon was taken back to its anatomical position, the radial head reduction was performed successfully. The patient achieved a complete functional recovery. Possible injury mechanisms are discussed, as well as the importance of identifying such a rare injury.

Irreducible anteromedial radial head fracture-dislocation: value of pre-operative magnetic resonance imaging

“…Irreducible anteromedial dislocations or anteromedial fracture-dislocations of the radial head are rare. 2,3,[5][6][7][8] Ozan et al had summarised the literature on the various types of soft tissue interposition causing irreducible anteromedial radial head dislocation. 5 The variety of soft tissue interposition which limits closed reduction is fairly broad, ranging from the joint capsule, tendinous structures or the annular ligament.…”

“…The involvement of the biceps tendon had been reported in the surgical literature. 8,9,11,12 Various descriptors such as the biceps tendon 'clinging' or 'transposed' around the radial head were used. Veenstra et al had also postulated in 1993 that the radiographic anteromedial position of the radius may be pathognomonic for biceps tendon interposition.…”

Traumatic Anteromedial Radial Head Dislocation in an Adult: A Case of Brachialis Tendon Entrapment

“…Traumatic radial head dislocation is usually associated with fractures of the forearm [ 1 , 4 - 8 ]. Isolated radial head dislocation in adults is rare [ 1 - 8 ].…”

“…Isolated traumatic anteromedial radial head dislocation in adults is rarely reported in the literature [ 4 - 5 ]. Only two cases of an irreducible anteromedial radial head dislocation due to soft tissue interposition have been reported in adult patients [ 4 - 5 ].…”

“…Isolated traumatic anteromedial radial head dislocation in adults is rarely reported in the literature [ 4 - 5 ]. Only two cases of an irreducible anteromedial radial head dislocation due to soft tissue interposition have been reported in adult patients [ 4 - 5 ]. Moreover, inability to perform the radial head reduction due to brachialis tendon interposition is a very rare situation, with only one such case previously published in the literature [ 1 , 4 - 7 ].…”