Abstract
Introduction
Acquired chronic radial head (RH) dislocations present a significant surgical challenge. Co-existing deformity, length discrepancy and RH dysplasia, in multiply operated patients often preclude acute correction. This study reports the clinical and radiological outcomes in children, treated with circular frames for gradual RH reduction.
Materials and Methods
Patient cohort from a prospective database was reviewed to identity all circular frames for RH dislocations between 2000–2021. Patient demographics, clinical range and radiographic parameters were recorded.
Results
From a cohort of 127 UL frames, 30 chronic RH dislocations (14 anterior, 16 posterior) were identified. Mean age at surgery was 10yrs (5–17). Six pathologies were reported (14 post-traumatic, 11 HME, 2 Nail-Patella, 1 Olliers, OI, Rickets).
70% had a congruent RH reduction at final follow-up. Three cases re-dislocated and 6 had some mild persistent incongruency. Average follow up duration was 4.1yrs (9mnths-11.5yrs). Mean radiographic correction achieved in coronal plane 9o, sagittal plane 7o and carrying angle 12o. Mean ulna length gained was 7mm and final ulnar variance was 7mm negative (congenital). All cases achieved bony union with 2 requiring bone grafting. Mean frame duration was 166 days. Mean final range of motion was 64osupination, 54 o pronation, 2o to 138o flexion. 5 complications and 7 further operations were reported.
Conclusions
The majority of children having frame correction achieve complete correction or minor subluxation, which is well tolerated clinically. Frame assisted reduction is an effective tool for selective complex cases irrespective of the pathology driving the RH dislocation.
