title: Case report: congenital dislocation of the radial head -a two-in-one approach.
abstract: BACKGROUND
  Congenital dislocation of the radial head of the elbow is rare. It is genetically transmitted in some cases and is often associated with syndromes, such as Nail-Patella syndrome, antecubital pterygium and ulnar dysplasia. About two thirds are posterior, with the remainder being either anterior (15%) or lateral (15%). The natural history of the condition is that symptoms are relatively benign, with only some limitation of motion and deformity. Treatment either involves early attempts at reconstruction or delayed intervention at skeletal maturity with radial head excision. We evaluated the radiographic and functional results of a two-in-one procedure (radial shortening and open reduction) in the treatment of congenital dislocation of the radial head of an eight year old girl.
  
  
  OBJECTIVE
  To describe a technique for easy reduction and maintenance of normal radiocapitellar joint anatomy in cases of congenital dislocation of the radial head.
  
  
  METHODS
  We have introduced one modification to the Sachar's method of open reduction by adding radial shortening. This can be described as a 'two incision approach' with the first incision for the radial shortening and the second for the open reduction of the radiocapitellar joint. The radial shaft was osteotomised first before we performed the radial head relocation. Then the overlapping part of radial shaft was trimmed. It was stabilized with a transarticular K wire fixation.
  
  
  RESULTS
  At one year follow up, the elbow is stable with no valgus or fixed flexion deformity. Supination has increased to 40 degrees from zero degrees. An X-ray showed reformation of the radial head with good congruity of the radiocapitellar joint and correction of the radial bow.
  
  
  CONCLUSIONS
  As far as the authors are aware, this is the first report of congenital dislocation of the radial head being treated by radial shortening and open reduction of radiocapitellar joint through a two incision approach (two-in-one approach). This paper describes this new technique, which we implemented for easy reduction maintenance of normal radiocapitellar joint anatomy.
authors.affiliation: Department of Orthopaedics, Government Medical College, Kozhikode, 673008, India.
authors.forename: Raju
authors.initials: R
authors.lastname: Karuppal
authors.affiliation: Department of Orthopaedics, KMCT Medical College, Kozhikode, 673603, India.
authors.forename: Anwar
authors.initials: A
authors.lastname: Marthya
authors.affiliation: Department of Orthopaedics, Government Medical College, Kozhikode, 673008, India.
authors.forename: Rajendran V
authors.initials: RV
authors.lastname: Raman
authors.affiliation: Department of Orthopaedics, Government Medical College, Kozhikode, 673008, India.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Somasundaran
keywords: Congenital dislocation of the radial head; Valgus deformity; Open reduction; Reconstruction; Two in one approach