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Posterolateral Rotatory Instability of the Elbow Following Radial Head Resection
Jeremy A. Hall, MD, FRCS(C)1; Michael D. McKee, MD, FRCS(C)1
1 Division of Orthopaedics, Department of Surgery, St. Michael's Hospital and the University of Toronto, 55 Queen Street East, Suite 800, Toronto, Ontario M5C 1R6, Canada. E-mail address for M.D. McKee: mckee@the-wire.com
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Investigation performed at the Division of Orthopaedics, Department of Surgery, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jul 01;87(7):1571-1579. doi: 10.2106/JBJS.D.02829
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Background: Resection is a common procedure for the treatment of comminuted fractures of the radial head. While radial head resection is associated with a high success rate when performed for appropriate indications, a number of well-defined biomechanical complications have been reported following this procedure, including proximal migration of the radius, the development of valgus deformity, and recurrent elbow instability in the acute setting. However, posterolateral rotatory instability has not previously been recognized as a complication of radial head resection. While the absence of the radial head makes the diagnosis difficult, we have identified a series of patients with posterolateral rotatory instability following radial head resection. We believe that this instability is secondary to unrecognized lateral ulnar collateral ligament deficiency.

Methods: Between November 1995 and September 2000, forty-two patients were evaluated because of elbow or forearm complaints following radial head resection. Seven patients (17%) were diagnosed with posterolateral rotatory instability on the basis of characteristic clinical and radiographic findings.

Results: The study group included five men and two women with a mean age of forty-two years. All seven patients had had radial head excision for the treatment of a comminuted radial head fracture at a mean of forty-four months (range, four months to sixteen years) prior to referral. All seven patients had lateral elbow pain, a sense of instability and/or weakness, and a positive lateral pivot-shift test. Posterolateral rotatory instability secondary to lateral ulnar collateral ligament insufficiency was confirmed intraoperatively in the four patients who were managed surgically.

Conclusions: Clinicians should be aware that posterolateral rotatory instability may be a cause of unexplained elbow pain and instability following radial head resection. This diagnosis has implications for the prevention and treatment of this condition.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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