: The treatment of chronic radial head dislocation remains controversial.
High rates of redislocation and complications have been reported
after surgery. In our view, correction of malalignment with ulnar
osteotomy is the key to a good surgical result.
Since 1975, twenty-two patients were treated surgically for chronic
radial head dislocation at our hospital. The procedure consisted
of open reduction of a dislocated radial head followed by radial
and/or ulnar osteotomy, with or without reconstruction of the annular
ligament or by reconstruction of the annular ligament alone. The
ages of the patients ranged from four to twenty years. In 1991,
we modified the surgical technique by performing an oblique ulnar
osteotomy with angulation and elongation and rigid plate fixation.
Bone-grafting at the osteotomy site was also performed if necessary.
A cast was applied with the forearm in neutral rotation and was worn
for two to four weeks. Nine patients were treated with this modified
The mean interval between the initial injury and the reconstructive
surgery was ten months. There were no serious surgical complications.
Of the thirteen patients treated before 1991, four had a good reduction
and seven had redislocation. Seven patients had restricted forearm
rotation postoperatively. Of the nine patients treated with the
modified osteotomy since 1991, seven had a good reduction. Two patients,
who had had slight radial head deformity preoperatively, had subluxation postoperatively.
Two patients had restricted forearm rotation.
Since we modified our technique for ulnar osteotomy, good reduction
of the radial head has been achieved without causing serious contracture.
Both angulation and elongation of the ulna are required to allow
the radial head to reduce.