Rare Cause of Block to Reduction After Radial Head Dislocation in Children

Aversano, Frank; Kepler, Christopher K.; Blanco, John S.; Green, Daniel W.

doi:10.1097/bot.0b013e3181dc245d

Cited by 14 publications

(13 citation statements)

References 8 publications

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“…Closed reduction was attempted in this case, but it failed because of buttonholing of the radial head through the capsule of the joint, which was discovered during surgery, along with a torn annular ligament. Similar cases of close reduction failure because of buttonholing of the anterior capsule have been reported in Japan by Takase et al[ 8 ] and in the United States by Aversano et al[ 10 ]. The anatomic pathology of anterior transolecranon fracture dislocation described by Tiemdjo et al[ 11 ] and as shown in Table 1 , includes 4 types, each with a proposed treatment.…”

Section: Discussionsupporting

confidence: 76%

Anterior transolecranon dislocation of the elbow in a child: A case report and review of literature

Bouaziz¹,

Guidara²,

Trabelsi³

et al. 2018

WJO

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Anterior transolecranon dislocation of the elbow is rarely observed in children, reported in only a small series. The present case involves an anterior transolecranon dislocation of the left elbow joint in a 7-year-old child, which was surgically treated. Two attempts of closed reduction failed because the radial head had buttonholed via the joint capsule. After its release, open reduction was easily performed; osteosynthesis of the olecranon was not performed. Remarkably, good result was obtained, despite a mild flexion deformity at the last follow-up. This case report aims to highlight this treatment method, which may be considered for such an uncommon injury.

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Section: Discussionsupporting

confidence: 76%

Anterior transolecranon dislocation of the elbow in a child: A case report and review of literature

Bouaziz¹,

Guidara²,

Trabelsi³

et al. 2018

WJO

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“…There is no consensus on which position of forearm rotation is best for stabilization of the radial head. Several authors have recommended that the forearm be immobilized in supination rather than in neutral rotation or pronation, while others have recommend the neutral rotation after manual reduction of the radial head [ 8 , 13 – 16 ]. The current results comparing stability among different forearm positions indicate that the ideal stabilizing position may differ depending on the direction of radial head dislocation.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical study of isolated radial head dislocation

Hayami

Omokawa

Iida

et al. 2017

BMC Musculoskelet Disord

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BackgroundIsolated radial head dislocation is a rare injury with an unclear pathomechanism, and the treatment is controversial. The purpose of the present study was to investigate the biomechanical contributions of the annular ligament, quadrate ligament, interosseous membrane, and annular ligament reconstructions to proximal radioulnar joint stability.MethodsFive fresh frozen cadaveric upper extremities were amputated above the elbow and solidly fixed on a customized jig. Radial head dislocation was reproduced by sequential sectioning of ligamentous structures and passive mobility testing. Radial head displacement during mobility testing was measured with an electromagnetic tracking device in three forearm rotation positions. The data were compared among different sectioning stages and between two types of simulated ligamentous reconstruction.ResultsLateral displacement of the radial head significantly increased in the neutral forearm rotation after annular ligament sectioning (46 ± 10%, p < 0.05). After quadrate ligament sectioning, we found significant posterior (67 ± 36%, p < 0.05) and lateral (74 ± 24%, p < 0.01) displacement in neutral forearm rotation and pronation. Significant radial head displacement was found in all directions and in all forearm positions after sequential sectioning of the proximal half of the interosseous membrane. Anatomical annular ligament reconstruction stabilized the proximal radioulnar joint except for anterior laxity in neutral forearm rotation (15 ± 6%, p < 0.05). The radial head with Bell Tawse procedure was significantly displaced in all directions.ConclusionThe direction of radial head instability varied depending on the degree of soft tissue sectioning and specific forearm rotation. Anterior radial head dislocation may involve more severe ligament damage than other types of dislocation. Anatomical annular ligament reconstruction provided multidirectional radial head stability.

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“…The anterior subluxed radial head appears to be medially displaced on the anteroposterior radiograph under the influence of the biceps tendon wrapped around the lateral aspect of the radial neck. This has been reported in children with and without an associated Monteggia fracture-dislocation1, 2, 12, 17, 18 and in adults without an ulna fracture 16 . In the latter case, the authors performed a cadaver re-creation of the injury.…”

Section: Discussionmentioning

confidence: 88%