Radial head excision and Achilles allograft interposition arthroplasty for the treatment of chronic pediatric radiocapitellar pathologies: A report of four cases

Abstract

Background Severe radiocapitellar pathologies represent a unique problem in the pediatric population, as radial head excision can lead to substantial long-term complications. We present a case series of four pediatric patients treated by a novel technique—radial head excision followed by Achilles allograft interposition arthroplasty. Methods Four children (ages 12–15 years) are described. Their clinical and radiographic outcomes were assessed by a visual analog scale, the Mayo Elbow Performance Score, the Disabilities of the Arm, Shoulder and Hand questionnaire, grip strength, and range of motion. Results At a mean follow-up of two years, the average flexion-extension arc of motion improved from 107° to 131°, and the rotation arc improved from 100° to 154°. The average visual analog scale, Mayo Elbow Performance Score, and Disabilities of the Arm, Shoulder and Hand scores were 2, 92.5, and 11.5, respectively. Two patients required subsequent additional procedures—manipulation under anesthesia and ulnar shortening osteotomy. Proximal migration of the radius was observed in three out of the four patients. Discussion Combined radial head excision and Achilles allograft interposition arthroplasty represents a viable option for the treatment of chronic pediatric radiocapitellar pathologies, with good results in terms of clinical and functional outcomes as well as patient satisfaction in the short-medium term.

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

“…In all patients, proximal migration of the radius occurred despite the allograft interposition. 10 We also saw problems at the wrist associated to the procedure in almost all patients. They were similar to the previously reported problems with pain at the DRUJ, ulna plus variance and instability and secondary procedures followed in two patients with ulnar shortening osteotomy with gracilis membrane stabilization.…”

“…2,3 It has been described by few authors in small patient populations. [4][5][6][7][8][9][10] Dreaded complications after radial head excision are proximal migration of the radius which leads to relative ulna positive variance increase at the wrist, regrowth of the radial head, cross-union, valgus deformity or instability of the elbow, which has been mainly described after resection of the radial head in congenital [11][12][13][14][15] resulting in poor outcomes. 5 The purpose of the study was to evaluate clinical and radiographic outcomes after radial head resection for posttraumatic disorders in children and adolescents in addition to a review of the literature.…”

Autologous replacement of the head of the radius—proximal fibula versus second metatarsal base: an anatomic feasibility study

“…To compensate for the suboptimal fit of the second metatarsal base to the radial notch of the ulna, an additional anconeus interposition ( 49 ), Achilles tendon interposition ( 9 ) or corium interposition ( 11 ) could be options to optimize the radioulnar movability. Alternatively, a costochondral graft has been described especially for bone replacement in children.…”

“…Secondary corrective osteotomy techniques are usually effective in reliably realigning the proximal radius since the head of the radius has usually lost its anatomic orientation and congruency. Hence, radial head resection might be the only solution to reduce pain and improve function in this patient cohort ( 9 – 12 ). However, such procedure is not without risks due to the potential occurrence of lateral elbow instability and longitudinal forearm instability ( 12 , 13 ).…”

“…The latter may cause a vicious circle of consecutive ulnocarpal impaction syndrome with a need of ulnar shortening procedures due to the proximal radial migration ( 14 ). To prevent such occurrence, multiple interposition arthroplasty techniques have already been described for the pediatric population ( 9 , 11 ).…”