Irreducible Isolated Radial Head Dislocation in a Child Due to Annular Ligament Interposition: A Case Report

TL;DR

A child with a rare elbow injury had successful surgery after failed attempts to fix it without surgery.

Contribution

This case report highlights the rare occurrence of irreducible radial head dislocation in children due to annular ligament interposition.

Findings

An 11-year-old boy with radial head dislocation required surgery after failed closed reduction.

The patient achieved full elbow motion and stability one year post-surgery.

Isolated radial head dislocations in children are rare and often require surgical intervention.

Abstract

The annular ligament of the elbow is essential for its stability, playing a key role in both the proximal radioulnar and humeroradial joints, as well as supporting surrounding muscles and ligaments. Radial head dislocation is rare in children, and when isolated they can be challenging to reduce and may require surgical intervention.

An 11-year-old boy presented with an anteromedial dislocation of the radial head after a fall. Initial, closed reduction was attempted and failed, requiring surgical intervention, where we found a rupture of the annular ligament and interposition, which was repaired after reduction. At one year of follow-up, the patient achieved full range of motion and stability of the elbow.

Radial head dislocation is rare in children and even more rare without associated ulna fractures. Evaluating radiographs for plastic deformities of the ulna is crucial, as these injuries are often overlooked. Failed closed reductions may rise suspicion of interposed structures.

Isolated post-traumatic radial head dislocation is a rare occurrence requiring prompt recognition and management. While most cases are treated with closed reduction, those that are not reducible or suspected soft tissue interposition may require open reduction. Thorough clinical evaluation, both vascular and neurologic and preoperative imaging are essential. Early intervention and meticulous surgical techniques can lead to favorable functional outcomes.

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