Congenital dislocation of the radial head was described by McFarland. The direction of the displacement of the radial head may be anterior or posterior or lateral.
Condition is often unilateral.
The abnormality is usually not detected at birth, but is diagnosed later on in childhood when the elbow is examined following some minor injury.
Usually the elbows are asymptomatic. A complaint of stiffness may be reason of visit to physician in some cases.
The ulna is bowed, the direction of convexity depending on the type of dislocation
- Anterior dislocation-ulnar bow is forward
- Posterior dislocation-backward
- Lateral dislocations the ulna will bend laterally.
In anterior dislocations the range of elbow flexion is limited and the radial head may be palpated in the cubital fossa; in posterior dislocations the elbow will not extend fully and the prominent radial head may be palpated posteriorly.
In a normal elbow a line drawn through the longitudinal axis of the radial shaft bisects the capitellum of the humerus. This normal finding is absent in this condition. The head of the radius is dome shaped on its superior surface.
It is important to distinguish traumatic from congenital dislocations. The types of injury that cause traumatic dislocation of the radial head are missed Monteggia fracture dislocations, fracture of the radial neck, pulled elbow, and occasionally a primary traumatic dislocation of the radial head with other associated injury.
In the newborn and infant, arthrography of the elbow is helpful in the definitive diagnosis of radial head dislocation.
When the diagnosis is made in the newborn or young infant, closed reduction may be attempted.
The posteriorly dislocated radial head is reduced by supination of the forearm and extension of the elbow,
The anteriorly dislocated radial head is reduced by flexion of the elbow.
Reduction is maintained in an above elbow cast for four to six weeks.
Closed reduction is often unsuccessful.
In children up to three years of age open reduction should be carried out.
In the older child it will be impossible to reduce the radial head.
The dislocation is left alone until late adolescence, when if symptoms warrant, the radial head is excised.
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