Updated: 5/21/2021

Congenital Radial Head Dislocation

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  • Introduction
    • Congenital radial head dislocation
      •  can be differentiated from traumatic dislocation by
        • bilateral involvement
        • hypoplastic capitellum
        • convex radial head
        • other congenital anomalies
        • lack of history of trauma
        • difficult to reduce
  • Epidemiology
    • Incidence
      • rare
        • < 1 per 100,000
    • Anatomic location 
      • Posterior dislocation (~70%) more common than anterior (15%) and lateral dislocation (15%)
      • bilateral in the majority of cases 
  • Etiology
    • Pathoanatomy
      • almost always posterior dislocation of radial head
      • often combined with bowing of the radius
      • the radius often appears too long compared to the ulna
    • Associated conditions
      • may have concurrent congenital anomalies
  • Anatomy
    • Elbow Anatomy & Biomechanics
  • Presentation
    • Symptoms
      • patients often asymptomatic
      • limited elbow ROM
    • Physical exam
      • radial head prominence
      • can have limited elbow ROM
        • especially in extension and supination
        • usually painless
  • Imaging
    • Radiographs
      • radial head posterior to capitellum
      • radial head can be large and convex ("dome" shaped)
      • radius is short and bowed
  • Treatment
    • Nonoperative
      • observation
        • indications
          • first line of treatment
    • Operative
      • radial head resection
        • indications
          • usually done in adulthood if patient has
            • significant pain
            • restricted motion
            • cosmetic concern of elbow
        • outcomes
          • reduces pain
          • may improve some elbow ROM
Flashcards (1)
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Questions (3)

(SBQ13PE.113) A 7-year-old nonverbal boy with severe Autism is brought to the emergency department by his caretaker after noticing a bump over the left elbow. She states that the patient falls often but is not sure when the bump first appeared. The patient moves his bilateral upper extremities spontaneously and without apparent discomfort. Examination of his left elbow is notable for a prominence over the posterolateral elbow that is nontender. Plain radiographs are pictured in Figures A and B. What is the next best step in management?

QID: 5359
FIGURES:
1

Plain radiographs of the contralateral elbow

83%

(2978/3584)

2

Closed reduction under sedation

10%

(373/3584)

3

Open reduction with annular ligament reconstruction

3%

(119/3584)

4

Open reduction with ulna osteotomy

2%

(56/3584)

5

Radial head resection

1%

(33/3584)

L 2 C

Select Answer to see Preferred Response

(OBQ13.143) A 17-year-old boy presents with pain in his right elbow for 2 years and limitation in elbow motion bilaterally. He denies any pain or discomfort in his left elbow. He reports no history of trauma to either elbow. He has had two courses of physical therapy, but has noted no noticeable improvement in pain or motion. Examination demonstrates no elbow tenderness on palpation, and there are no neurological deficits. Manual reduction is unsuccessful. The range of motion of both elbows is shown in Figure A. Radiographs of left and right elbow are shown in Figure B and C respectively. What is the most appropriate treatment plan for the right and left elbow?

QID: 4778
FIGURES:
1

Bilateral open reduction and application of a hinged external fixator to both elbows

3%

(99/3507)

2

Radial head resection of the right elbow and non-operative management of the left elbow.

81%

(2831/3507)

3

Bilateral radial head arthroplasty

3%

(115/3507)

4

Physical therapy and splinting to both elbows

7%

(242/3507)

5

Radial head resection and interposition arthroplasty for the right elbow and radial head resection alone for the left elbow

6%

(200/3507)

L 2 C

Select Answer to see Preferred Response

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