Hi Dear Dr.,
I Think this case deserves anterior
approach for the elbow and resection of the exostosis
and trial for radial head reduction which I think it
would be an easy job. In case of difficulty, you
should be prepared for radial head resection.
I hope you all success in your durgery.
M M Kotb, Hand and Reconstructive Microsurgery Unit,
Orthopedic Department, Assiut University Hospitals,
Assiut, Egypt
we must remove the exastosis and repar the anular lig. if preasent or
replace by tendon
Assalam o alaikum
I suggest for the this case ( open reduction and reconstruction of the annular ligament by a triceps slip, and osteotomy of the ulna)
The operation is not that difficult as it sounds and i hope you will get good result.
Post operatively one must be sure that Elbow is not immobilised for longer period. Passive exercises need to be started after 2 to three weeks. With out Ulnar osteotomy the recurrence is high and not acceptable.
Masalam
Khurshid.
Dear Dr. :
This is an interest case.
My advice is to have a magnified view for the elbow AP
for both sides ( rt and left ) and lateral view too
for both sided ( rt and lt ) then compare well. Most
propably the dislocation is due to partial physeal
growth arrest of radial head physis and it is the same
cause of the spurs. If that the condition, so complete
physiodesis of both bones proximally is advised
otherwise the problem will increase till natural
physiological arrest will occur.
Dear Dr ,
Thanks for your E-Mails,
There is bone swelling in ulnar coronoid process region pushing the radius .....
I think it simple excision of the swelling will do.
thanks
Jamal Assobhi
I feel it is nothing but exostosis. Excise it. Radial head will get back to a better position. You will be able to appreciate the gain in range of movements peroperatively.
Dr.Dominic Puthoor
Orthopedic Oncologist
Amala Institute of Medical Sciences
Thrissur,Kerala,India
Hi Dr. ,
IMHO this is a typical case of p/trauma heterotopic ossification with a deformed subluxated radial head (closed epiphysis). Almost complete proximal radio-ulnar bony bridge. I would approach anteriorly (Henry’s) and excise the “bridge”, aiming to trim the medial radial head articular edge and stabilize the radius if congruate with the capitellum. If there is no way to restore the proximal R-U j & radio-capitellar j I would excise the radial head and replace it with metal head (in spite the fact that he is only 15Y) in order to avoid future overloading of the ulno-humeral joint. I would begin p/o immediate mobilization and preventive treatment to avoid recurrent ossification. This is a case that in any way a compromise should be taken in consideration ….the patient and his parents should understand completely the risks - PIN damage, infection, recurrent HO, loss of ROM and probably more surgeries in the future (in a case the radial head should be replaced). I am not sure but from the lateral xray I suspect PLRI??
Good luck
luboshitz shmuel
Head of the Hand Surgery Unit
Hillel-Yaffe Med. Center