Joana Monteiro Pereira*, Ana Esteves, Pedro Ribeiro, Francisco Bernardes, Tiago Costa and Pedro Barreira

Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal

*Corresponding Author: Joana Monteiro Pereira, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal.

Received: August 30, 2021; Published: September 18, 2021

Abstract

Chronic radial head dislocation is a rare and potentially devastating injury in pediatric population, resulting in long term function and movement impairment. Early recognition and management are essential to restore elbow flexion and more important pronation and supination.

The treatment of chronic radial head dislocations in children can be challenging and currently there is no consensus on the optimal treatment.

The authors describe a case of a 6-year-old boy who suffered a fall onto his outstretched left arm, with 6 weeks evolution, and sustained a left radial head fracture with anterior dislocation, without ulnar deformity. A Boyd and Speed approach was made, and a modified Bell Tawse procedure was performed using a lateral slip of the triceps tendon, passed around the radial neck and fixed with a suture anchor into ulna.

This versatile approach allowed access to all the structures, minimizing the risk of surgical scarring, with excellent functional and imagiologic results, without long-term major complications.

To our knowledge, there are no reported cases regarding an annular ligament reconstruction using a modified Bell Tawse procedure with suture anchor.

Level of evidence IV.

Keywords: Bell Tawse Technique; Radial Head Dislocation; Ulnar Bowing

References

1. Kim HT., et al. “Chronic radial head dislocation in children, Part 1: pathologic changes preventing stable reduction and surgical correction”. Journal of Pediatric Orthopaedics 22 (2002): 583.
2. Lei Tan., et al. “Modified technique for correction of isolated radial head dislocation without apparent ulnar bowing: a retrospective case study”. International Journal of Clinical and Experimental Medicine10 (2015): 18197-11820.
3. Ruchelsman DE., et al. “Persistent posterior interosseous nerve palsy associated with a chronic type I Monteggia fracture-dislocation in a child: a case report and review of the literature”. Hand 4 (2009): 167-172.
4. Horii E., et al. “Surgical treatment for chronic radial head dislocation”. Journal of Bone and Joint Surgery American 84-A (2002): 1183-1188.
5. Bhaskar A. “Missed Monteggia fracture in children: Is annular ligament reconstruction always required?” The Indian Journal of Orthopaedics 43 (2009): 389-395.
6. Thompson JD and Lipscomb AB. “Recurrent radial head subluxation treated with annular ligament reconstruction: A case report and follow-up study”. Clinical Orthopaedics and Related Research 246 (1989): 131.
7. Futami T., et al. “Rotation osteotomy for dislocation of the radial head 6 cases followed for 7 (3-10) years”. Acta Orthopaedica Scandinavica 63 (1992): 455-456.
8. Mehta SD. “Flexion osteotomy of ulna for untreated”. Strategies in Trauma and Limb Reconstruction1 (2007): 31-34.
9. Wang MN and Chang WN. “Chronic posttraumatic anterior dislocation of the radialhead in children: thirteen cases treated by open reduction, ulnar osteotomy, and annular ligament reconstruction through a Boyd incision”. Journal of Orthopaedic Trauma 20 (2006): 1-5.
10. Inoue G and Shionoya K. “Corrective ulnar osteotomy for malunited anterior Monteggia lesions in children: 12 patients followed for 1-12 years”. Acta Orthopaedica Scandinavica 69 (1998): 73-76.
11. Cohen MS and Hastings H. “Rotatory Instability of the Elbow. The Anatomy and Role of the Lateral Stabilizers”. Journal of Bone and Joint Surgery American 79 (1997): 225-233.
12. Søjbjerg J., et al. “The stability of the elbow following excision of the radial head and transection of the annular ligament”. Archives of Orthopaedic and Trauma Surgery 106 (1987): 248-250.
13. Dunning CE., et al. “Ligamentous stabilizers against posterolateral rotatory instability of the elbow”. Journal of Bone and Joint Surgery American 83 (2001): 1823-1828.
14. Ghinea CA., et al. “Burnei's technique in the treatment of radial head displacement; innovative surgery: Study on two cases”. The Journal of Medicine and Life 6 (2013): 26-33.
15. Rodgers WB., et al. “Chronic Monteggia lesions in children: Complications and results of reconstruction”. Journal of Bone and Joint Surgery American 78 (1996): 1322-1329.
16. Fowles JV., et al. “The Monteggia lesion in children: Fracture of the ulna and dislocation of the radial head”. Journal of Bone and Joint Surgery American 65 (1983): 1276.
17. Lloyd-Roberts G and Bucknill T. “Anterior dislocation of the radial head in children: aetiology, natural history and management”. The Journal of Bone and Joint Surgery. British 59 (1977): 402.
18. Brian J Cole., et al. “Fixation of Soft Tissue to Bone: Techniques and Fundamentals”. The Journal of the American Academy of Orthopaedic Surgeons2 (2016): 83-95.
19. Park MC., et al. “Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques”. American Journal of Sports Medicine8 (2005): 1154-1159.
20. Thompson JD and Lipscomb AB. “Recurrent radial head subluxation treated with annular ligament reconstruction: A case report and follow-up study”. Clinical Orthopaedics and Related Research 246 (1989): 131.
21. Galik K., et al. “The effect of the annular ligament on kinematics of the radial head”. Journal of Hand Surgery 32 (2007): 1218-1224.

Citation

Citation: Joana Monteiro Pereira., et al. “Modified Bell Tawse Technique for Correction of Pediatric Isolated Radial Head Dislocation without Ulnar Bowing". Acta Scientific Orthopaedics 4.10 (2021): 54-59.

Copyright

Copyright: © 2021 Joana Monteiro Pereira., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.