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      Congenital radial head dislocation with a progressive cubitus valgus: a case report

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          Abstract

          Congenital dislocation of the radial head is rare, although it is the most common congenital anomaly of the elbow. A concomitant progressive cubitus valgus of the elbow has not previously been described in literature. We describe a case of an 8-year-old girl with an unilateral congenital radial head dislocation with a progressive cubitus valgus of 35°, caused by a prematurely closing physis of the lateral humeral condyle. This might be caused by an increased pressure on the lateral physis by the anteriorly dislocated radial head. As no complaints or limitations were present, treatment was non-operative with clinical observation, with satisfactory results after a follow-up of 18 months. A concomitant progressive cubitus valgus can be present in patients with a congenital radial head dislocation. Non-operative treatment can provide satisfactory results.

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          Most cited references21

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          Chronic radial head dislocation in children, Part 2: results of open treatment and factors affecting final outcome.

          Fifteen elbows (3 congenital, 12 traumatic) in 14 children (mean age 9.5 years) with chronic radial head dislocation for at least 3 months (range 3-180 months) underwent radial head-sparing reconstructive surgery and were followed up at an average of 43.5 months postoperatively (range 12-105 months). At follow-up, the patients were evaluated radiographically and clinically using range-of-motion measurements and an elbow performance score based on four parameters (deformity, pain, motion, function). Ten cases had excellent results, two had good results, two had fair results, and one case had poor results. Scores at follow-up were evaluated with seven preoperative factors. Among those, the degree of preoperative carrying angle asymmetry associated with flexion contracture correlated significantly with the elbow scores. The most common complication was loss of pronation. The authors advocate radial head reduction and reconstruction in chronic radial head dislocations in children after obtaining informed consent from patient and parents.
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            Chronic radial head dislocation in children, Part 1: pathologic changes preventing stable reduction and surgical correction.

            The pathologic changes in 15 elbows of 14 children (2 bilateral congenital, 12 unilateral posttraumatic, mean age 9.5 years) with radial head dislocation unreduced for at least 3 months (range 3-180 months) and their open treatment were reviewed. Common dysplastic changes observed in both congenital and posttraumatic groups included large deformed radial heads, slender radial necks, and ulnar bowing. Changes were bilateral and symmetrical in the congenital group. In traumatic dislocations, patients with more severe deformities had longer delays from time of injury to time of reduction. Persistent pain, limitation of motion, and deformity were unacceptable symptoms to both patients and their parents, prompting surgical intervention. To produce a smooth rotational arc for the radius and maintain it in stable reduction, restoration of the congruency of the capitello-radioulnar joint and correction of the various dysplastic changes were mandatory during open reduction.
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              Long-term effects of neonatal bone and joint infection on adjacent growth plates.

              Review of children with physeal damage from neonatal infection other than the hip at Winnipeg Children's Hospital showed that six patients had residual growth interference from adjacent infection in the bone or joint. Several of the infections involved multiple joints, with growth plate arrest occurring in the distal femoral growth plate in four, in the proximal humerus in four, in the proximal femur in two, in the distal radius in one, and in the distal humerus in one. Although the initial infection was frequently believed to be successfully treated in the neonate, the clinical effect of these infections on the growth plate was not fully appreciated in five of the infants until the children reached a mean age of 9 years. Because growth abnormalities in physeal bars may not be clinically evident for several years after the initial infection has been treated, we recommend that children with bone and joint infections occurring in the first month of life be followed to skeletal maturity, observing the adjacent physis for late tethering.
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                Author and article information

                Contributors
                +31-6-29260941 , laurenskaas@hotmail.com
                Journal
                Strategies Trauma Limb Reconstr
                Strategies Trauma Limb Reconstr
                Strategies in Trauma and Limb Reconstruction
                Springer Milan (Milan )
                1828-8936
                1828-8928
                6 January 2012
                6 January 2012
                April 2012
                : 7
                : 1
                : 39-44
                Affiliations
                [1 ]Department of Orthopaedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
                [2 ]Bethaniëplein 10, 3701 EM Zeist, The Netherlands
                Article
                126
                10.1007/s11751-011-0126-z
                3332326
                22223165
                4473c492-1111-4cf6-96b4-892a88650569
                © The Author(s) 2012
                History
                : 9 June 2011
                : 20 December 2011
                Categories
                Case Report
                Custom metadata
                © The Author(s) 2012

                Emergency medicine & Trauma
                review,cubitus valgus,anomaly,congenital radial head dislocation,treatment,elbow

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