title: Intermediate-term to long-term outcome of surgically and nonsurgically treated congenital, isolated radial head dislocation.
abstract: OBJECTIVE
  Adolescent patients with congenital radial head dislocation presenting with pain and limitation in motion might benefit from radial head excision. We report objective and patient-rated data for patients treated with radial head excision and those followed nonsurgically. We hypothesized that surgery would improve pain and motion and that outcomes and the need for additional surgery would be similar between the 2 groups.
  
  
  METHODS
  We reviewed our surgical logs and identified 16 patients (10 treated surgically and 6 treated nonsurgically) for participation. At a mean of 10 years for the surgical group and 16 years after initial office visit for the nonsurgical group, we collected patient-rated and objective data, including range of motion, strength, and pain at the wrist or elbow.
  
  
  RESULTS
  Eight of 16 patients had bilateral dislocations. Preoperative and postoperative elbow flexion (137° versus 135°) and extension (27° versus 23°) were unchanged in surgically treated patients. Forearm rotation was improved after surgery (100° versus 119°). Carrying angle was similar between surgical (17°) and nonsurgical (13°) elbows, but surgically treated elbows had significantly different ulnar variance at +4.9 mm compared to -0.4 mm for the nonsurgically treated patients. Surgically treated patients had significant improvement in elbow pain following radial head excision. Final Quick Disabilities of the Arm, Shoulder, and Hand scores were similar between groups, although there were lower mean scores among nonsurgically treated patients.
  
  
  CONCLUSIONS
  Radial head excision in patients with symptomatic, isolated, congenital radial head dislocations resulted in substantial pain relief and patient satisfaction but modest improvement in forearm rotation and no improvement in elbow flexion-extension. Furthermore, more than 25% of the surgically treated limbs developed wrist pain and needed additional surgery. The nonsurgical group did not lose motion, develop pain, or need surgery. This information might help make the decision whether to excise the radial head in patients with symptomatic, congenital radial head dislocation.
authors.affiliation: Department of Orthopaedic Surgery, Shriners Hospital for Children at Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bengard
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Calfee
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Steffen
authors.forename: Charles A
authors.initials: CA
authors.lastname: Goldfarb
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000503:physiopathology; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000151:congenital* / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D053580:Muscle Strength; D011884:Radius / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D000092464:Elbow Injuries