Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2015, vol. 21, issue 1
Subject Area: Medicine - Orthopedics and Traumatology
Pages: 757-762
DOI: 10.5272/jimab.2015211.757
Published online: 30 March 2015

J of IMAB 2015 Jan-Mar;21(1):757-762
Pencho KosevCorresponding Autor, Bojan Valentinov.
Department of orthopedics and traumatology, MHAT Ruse, Ruse, Bulgaria.

Purpose: To present the results of open reduction and angulating-distraction ulnar osteotomy in children with chronic radial head dislocation.
Material and Methods: This is a retrospective review of 4 children (3 girls, one boy) with chronic radial head dislocation treated in our hospital between 2009 and 2012. The average age at the time of surgery was 6.6 (4.2 – 9.1 years).The interval between initial trauma and surgery was from 2 to 25 months. Three of the patients had a plastic deformation of the ulna with a positive “ulnar bow sign” and one was with missed radial head dislocation after an equivalent injury.
The surgical strategy in all patients included proximal ulnar osteotomy with angulation and distraction and open reduction of the dislocated radial head without annular ligament reconstruction or pinning. Osteotomy was fixed with a prebent one-third tubular plate and a tricortical bone graft.
Results: The mean follow-up was 4 years (range 2.5 - 5.5). Radial head remained reduced and stable in all cases. All ulnar osteotomies healed without any complications. The postoperative range of motion was improved in all of the patients. Functional outcomes assessed by Elbow Performance Score were excellent in three and good in one of the patients.
Conclusions:The treatment of an unrecognized radial head dislocation in children continues to pose a therapeutic challenge. The osteotomy of the proximal ulna with both angulation and elongation allows stable radial head reduction without necessity of annular ligament reconstruction in most of the cases.

Key words: Chronic radial head dislocation, Monteggia lesion, children, ulnar osteotomy,

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Correspondence to: Assoc. Prof. Pencho Kosev, Department of orthopedics and traumatology, MHAT Ruse, 2, Nezavisimost str., 7000 Ruse, Bulgaria; E-mail:

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Received: 15 January 2015
Published online: 30 March 2015

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