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Radial Head Dislocation and Subluxation in Osteogenesis Imperfecta
Alice Marcdargent Fassier, MD1; Frank Rauch, MD2; Mehdi Aarabi, MD3; Chantal Janelle, MD, FRCS2; François Fassier, MD, FRCS2
1 Pediatric Orthopaedics Clinical Fell, McGill University, 1529 Cedar Avenue, Montreal, QC H3G 1AG, Canada. E-mail address: amarcdargent@shriners.mcgill.ca
2 Genetics Unit (F.R.), Pediatric Orthopaedics (C.J. and F.F.), and Hand and Upper Limb Surgery (C.J.), Shriners Hospital for Children, 1529 Cedar Avenue, Montreal, QC H3G 1A6, Canada. E-mail address for F. Rauch: frauch@shriners.mcgill.ca. E-mail address for C. Janelle: cjanelle@shriners.mcgill.ca. E-mail address for F. Fassier: ffassier@shrinenet.org
3 Department of Orthopaedic Surgery, Toronto East General Hospital, 825 Coxwell Avenue, Toronto, ON M4C 3E7, Canada. E-mail address: drmaarabi@yahoo.ca
View Disclosures and Other Information
Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Shriners Hospital, Montreal, Quebec, Canada

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2007 Dec 01;89(12):2694-2704. doi: 10.2106/JBJS.F.01287
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Background: Upper limb deformity in children with osteogenesis imperfecta may substantially impair function. The aims of this retrospective work were to study the prevalence of radial head malalignment (dislocation or subluxation) in different types of osteogenesis imperfecta and to identify factors linked to it.

Methods: We assessed 489 upper limbs from 254 patients (with a mean age of 9.6 years and including 130 female patients) who had various types of osteogenesis imperfecta. Radiographs representing a single time-point for each patient were assessed for the presence and direction of radial head malalignment and associated abnormalities (dysplasia of the capitellum or of the radial head or neck, calcification of the interosseous membrane, or radioulnar synostosis). Deformations of the humerus, radius, and ulna were assessed with regard to location, direction, and magnitude. The forearm range of motion in pronation and supination and the hand grip force were measured in a subset of patients.

Results: We observed radial head dislocation or subluxation in forty-four and thirty-nine upper extremities, respectively. The frequency of radial head malalignment was significantly higher in type-V osteogenesis imperfecta (86%) than in the other types (0% to 29%) (p < 0.001). Dysplasia of the humeral capitellum, radial head, or radial neck was associated with malalignment in all types of osteogenesis imperfecta, with the exception of capitellum dysplasia in type V. Malalignment in type V was associated with calcification of the interosseous membrane, an abnormality that was specific for type V. In the other osteogenesis imperfecta types, malalignment was commonly linked with radial and ulnar deformation and was associated with decreased forearm range of motion in supination and pronation and a lower grip force.

Conclusions: Radial head malalignment is common in osteogenesis imperfecta, especially in type V. Malalignment is associated with bowing characteristics and impaired function of the upper limb. These findings may provide support for surgical correction of radial and ulnar bowing in selected patients with osteogenesis imperfecta.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    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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