A retrospective analysis of the curative results of proximal ulnar rotation osteotomy for congenital anterior dislocation of the radial head in children

MIAO Wu-sheng; WANG Bing; WU Ge; WU Yong-tao; JIANG Hai; QU Ji-ning; LI Min; WANG Xiao-wei; LIANG Xiao-ju

doi:10.3969/j.issn.2095-252X.2017.07.007

Abstract：Objective To evaluate the curative results of self-designed proximal ulnar rotation osteotomy for the treatment of congenital anterior dislocation of the radial head. Methods From April 2008 to December 2015, 19 children with anterior dislocation of the radial head without a history of trauma were treated in our hospital. Firstly, one child was radiographically diagnosed with old Monteggia fracture before surgery with abnormal position of proximal radioulnar joint, which could not be treated by using old Monteggia procedures. We repositioned the radial head by cutting the proximal ulna and rotated the distal ulna back-outside. The MRI examination was performed in 18 cases of anterior dislocation of the radial head without a history of trauma before surgery. It showed that there were 8 cases of old Monteggia fractures and 10 cases of congenital anterior dislocation of the radial head. The main pathological changes included abnormal position of the proximal radioulnar joint, which was located in the anterior lateral side of the ulna rather than the outside. Based on the pathological changes, we designed proximal ulnar rotation osteotomy with ulnar radial complex on the backward of the lateral rotation to reset the radiocapitellar joint. Among the 11 patients treated with proximal ulnar rotation osteotomy, there were 7 boys and 4 girls whose average age was 6.1 years ( range: 2 - 12 years ). The curative results were retrospectively analyzed for 11 children with congenital anterior dislocation of the radial head by preoperative and postoperative radiographical and clinical evaluation of the elbow functions. Results All the patients were followed up for an average period of 26 months ( range: 12 - 70 months ). The radiography of the elbow showed that the radiocapitellar joint was reduced in all the patients, and radial head dislocation did not recur. No ulnar nonunion, elbow osteoarthritis, wound infection or nerve injury was observed in these patients. The carrying angle was obviously decreased ( P < 0.05 ). The elbow stability and range of elbow flexion motion were obviously improved ( P < 0.05 ). Conclusions The follow-up results have shown that proximal ulnar rotation osteotomy is an effective method for the treatment of congenital anterior dislocation of the radial head.