# Bell-Tawse procedure with cortical fixation using endo-button in anterior radial head dislocation: A case report

## TL;DR

A 26-year-old man with a rare anterior radial head dislocation was successfully treated using the Bell-Tawse procedure with endo-button cortical fixation, resulting in pain-free elbow function after one year.

## Contribution

This is the first reported case of using an endo-button in the Bell-Tawse procedure for anterior radial head dislocation in an adult.

## Key findings

- The patient experienced no pain and improved elbow function one year after the Bell-Tawse procedure with endo-button fixation.
- Endo-button use compensated for inadequate graft length in annular ligament reconstruction.
- The procedure successfully addressed chronic dislocation due to ulnar deformity and ligament failure.

## Abstract

Anterior radial head dislocations are rare in adults. Misdiagnosis to Monteggia fracture-dislocation can occur up to 28 %, which results in failed detection of the misaligned radiocapitellar joint. Anterior radial head dislocation is treatable using the Bell Tawse technique. However, reports regarding the technique are rare in adults, with no endo-button use.

A 26-year-old male came to the orthopedic outpatient clinic with left elbow pain as his chief complaint. The affected hand was a non-dominant hand. The patient had a work-related injury where the fractures were already immediately treated with open reduction internal fixation (ORIF) 4 months prior. Radiograph images showed anterior radial head dislocation with internally fixated distal-third humerus and proximal-third ulnar fractures. The patient was diagnosed with recurrent radial head dislocation post-Monteggia facture. The patient underwent Bell Tawse with cortical fixation using an endo-button.

After 1 year, the patient felt no more pain (visual analog scale (VAS) score 0). The patient was satisfied with the one-year outcome with improved elbow function. The American Shoulder and Elbow Surgeons (ASES) score and the disabilities of the arm, shoulder, and hand (DASH) score improved.

Endo-button hadn't been used in annular ligament reconstruction, especially the Bell Tawse procedure. In our report, we used endo-button cortical fixation to compensate for the inadequate graft length in an adult case. At the one-year follow-up, the patient had no complaints of pain and could do normal activities.

•Monteggia fracture-dislocations are rare in adults.•Chronic dislocation, often due to ulnar deformity and/or annular ligament failure•The use of endo-button helps in adding extra length to grafts.

Monteggia fracture-dislocations are rare in adults.

Chronic dislocation, often due to ulnar deformity and/or annular ligament failure

The use of endo-button helps in adding extra length to grafts.