Case report: congenital dislocation of the radial head –a two-in-one approach

Background: Congenital dislocation of the radial head of the elbow is rare. It is genetically transmitted in some cases and is often associated with syndromes, such as Nail-Patella syndrome, antecubital pterygium and ulnar dysplasia. About two thirds are posterior, with the remainder being either anterior (15%) or lateral (15%). The natural history of the condition is that symptoms are relatively benign, with only some limitation of motion and deformity. Treatment either involves early attempts at reconstruction or delayed intervention at skeletal maturity with radial head excision. We evaluated the radiographic and functional results of a two-in-one procedure (radial shortening and open reduction) in the treatment of congenital dislocation of the radial head of an eight year old girl. Objective: To describe a technique for easy reduction and maintenance of normal radiocapitellar joint anatomy in cases of congenital dislocation of the radial head. Method: We have introduced one modification to the Sachar’s method of open reduction by adding radial shortening. This can be described as a ‘two incision approach’ with the first incision for the radial shortening and the second for the open reduction of the radiocapitellar joint. The radial shaft was osteotomised first before we performed the radial head relocation. Then the overlapping part of radial shaft was trimmed. It was stabilized with a transarticular K wire fixation. Results: At one year follow up, the elbow is stable with no valgus or fixed flexion deformity. Supination has increased to 40 degrees from zero degrees. An X-ray showed reformation of the radial head with good congruity of the radiocapitellar joint and correction of the radial bow. Conclusion: As far as the authors are aware, this is the first report of congenital dislocation of the radial head being treated by radial shortening and open reduction of radiocapitellar joint through a two incision approach (two-in-one approach). This paper describes this new technique, which we implemented for easy reduction maintenance of normal radiocapitellar joint anatomy.