Orthopedics - Oleksa A.P. 2006

Congenital upper limb deformities
Congenital deformities of the forearm
Congenital dislocation of the radial head

Congenital Dislocation of the radial HEAD was first described in 1830 by Dupuytren and Loir. This congenital anomaly is relatively common and, according to Mordej, accounts for 0.34–0.96% of all orthopedic disorders. Notably, congenital dislocation of the radial head occurs three times more frequently in females than in males.

The radial head can dislocate in various directions, but anterior displacement is the most common (Fig. 116). In such cases, upper extremity function is impaired due to a severe restriction of forearm flexion at the elbow, and sometimes extension as well. Supination and pronation generally remain within the normal range, although supination may occasionally be slightly limited.

In congenital posterior dislocation of the radial head, forearm extension is severely restricted while flexion remains possible. Rotational Movements of the forearm are also sharply limited, and supination is entirely impossible.

In lateral congenital dislocations of the radial head, upper limb function is less severely impaired, with supination being either restricted or impossible. Over time, this leads to significant joint laxity in the elbow. As the child grows, the dislocated head loses its normal anatomical shape, becomes deformed, and the growth of the radius is disrupted, causing it to angle and even elongate.

It should be noted that congenital dislocation of the radial head may be associated with other congenital Anomalies of the upper limb or other parts of The Musculoskeletal System.

Treatment. There is no doubt that congenital dislocation of the radial head cannot be corrected using Conservative Methods. Surgical treatment should aim to restore the full range of forearm motion in the elbow joint across all planes. To prevent secondary joint changes, surgery is typically performed after children reach three years of age.

Class="center">

Fig. 116. Congenital dislocation of the radial head.

Reconstruction of the radioulnar joint is performed. Under general anesthesia, using Kocher's incision, the Joint Capsule is opened to expose the radial head. Surgery must be performed with caution to avoid injuring the deep branch of the radial nerve (ramus profundus n. radialis), which innervates the wrist extensors and is located within the displaced Tissues anterior to the elbow joint capsule. The surgeon attempts to identify and isolate the abnormal annular ligament (ligamentum annulare radii), which must be incised to release the proximal end of the radius. The radial notch (bed) on the ulna is then cleared of scar tissue and soft tissues. The head is reduced and fixed with the forearm flexed at 90°, using a Kirschner wire inserted percutaneously through the capitulum of the humerus (eminentia capitata). Subsequently, if possible, the annular ligament is sutured without tension, and the wound is closed with placement of a drain for 24 hours. The arm is immobilized in a plaster splint and placed on a wedge pillow. After 10 days, the bandage is loosened to begin gentle supination and pronation exercises. Two to three weeks postoperatively, the splint is removed, the Kirschner wire is extracted, and active and passive flexion-extension exercises of the forearm are initiated.

The later the surgical intervention is performed, the poorer the functional outcomes. In cases of failed reconstructive surgery and in children older than 14 years, excision of the radial head should be the Procedure of choice. The joint is accessed via Kocher's approach. The exposed head is excised following resection at the neck level. The annular ligament is reconstructed. Active-passive motion exercises are initiated on the fourth postoperative day.