Review Question - QID 804

The radiograph show a dislocation of the radiocapitellar joint. This is going to require open reduction due to the chronicity of the injury. Treatment options include annular ligament repair, ulnar osteotomy, radial osteotomy or a combination of these procedures. Also, the annular, quadrate, oblique & interosseous ligaments tighten in supination, providing further stability to the proximal radioulnar joint and decreasing the risk of re-dislocation.

It has been published by many authors, including Lincoln et al, that an isolated radial head dislocation does not occur in the pediatric population and that plastic deformation or malunion of the ulna is typically present creating a Monteggia fracture-dislocation variant. The ulnar deformity, if significant, may need to be addressed via osteotomy in the corrective procedure in order to obtain a secure reduction of the radiocapitellar joint. In treating the traumatic radial head dislocation, it is important to consider congenital radial head dislocation and occult Monteggia fracture (plastic deformation of the ulna) in the differential diagnosis as this could alter your treatment strategy.