Anterior Dislocation of the Radial Head Combined with Plastic Deformity of the Ulnar Shaft in an Adult: A Case Report

A 25-year-old woman presented to the emergency room with a painful and swollen right forearm. She had just sustained an injury from an accident during which her arm was tightly wound by a rope as she was lowering a net from a fishing boat. Before being released, her arm was rigidly trapped in the rope for approximately ten minutes. Radiographs revealed anterior dislocation of the radial head that was accompanied by plastic deformation of the proximal ulna, manifested as a reversal of the proximal dorsal angulation of the ulna (PUDA); suggested a Monteggia equivalent fracture. With the patient under general anesthesia, we reduced the radial head by posterior compression at 90° of elbow flexion and at neutral rotation of the forearm. However, the reduction was easily lost and the elbow re-dislocated with even slight supination or extension of the arm. After the osteotomy of the ulnar deformity to restore the PUDA to normal, the reduction remained stable even with manipulation of the arm. We found that the patient could exercise a full range of motion without pain at the 3-month follow-up, and neither residual instability nor degenerative changes were observed at the final 3-year follow-up.

Neuropatía por atrapamiento del nervio interóseo posterior en un adulto con displasia ósea / Entrapment neuropathy of the posterior interosseous nerve in an adult with bone displasia

Resumen: La neuropatía por atrapamiento del nervio Interóseo Posterior, rama motora del nervio radial, puede ser causada por la compresión estructural, mecánica, o dinámica en lugares específicos que conducen a la lesión del nervio. La proximidad del nervio interóseo posterior a la cabeza del radio lo hace susceptible a lesiones por eventos traumáticos agudos o crónicos, como manifestación tardía secundaria a luxación de la cabeza del radio. Esta última es una entidad poco frecuente en el adulto y siempre plantea diversos diagnósticos diferenciales referidos a su origen y eventual asociación con Acondroplasia. La patología compresiva del nervio Interóseo Posterior puede generar dos síndromes diferentes: Síndrome del nervio interóseo posterior o Síndrome del túnel radial. En este artículo se describe el caso de un adulto con una neuropatía por atrapamiento del nervio Interóseo Posterior, con subluxación unilateral de cabeza del radio y antecedentes personales de Displasia Ósea. A través del análisis de los estudios de electrodiagnóstico e imagenología, se plantean los diagnósticos diferenciales, etiológicos y diagnóstico positivo de Síndrome del nervio interóseo posterior. Así como su posibilidad de tratamiento conservador y quirúrgico.

Abstract: Entrapment neuropathy of the posterior interosseous nerve, motor branch of the radial nerve can be caused by structural, mechanical, or dynamic compression in specific locations that lead to nerve injury. The proximity of the posterior interosseous nerve to the radial head makes it susceptible to injury from acute or chronic traumatic events, such as late manifestation secondary to dislocation of the radial head. The latter is a rare entity in adults and always raises several differential diagnoses related to their origin and possible association with Achondroplasia. The compressive pathology of the posterior interosseous nerve can generate two different syndromes: posterior interosseous nerve syndrome or radial tunnel syndrome. This article describes the case of an adult with a posterior interosseous nerve entrapment neuropathy with unilateral radial head dislocation and personal history of Bone Dysplasia. Through analysis of electrodiagnostic and imaging studies, differential diagnoses, etiological and positive diagnosis of posterior interosseous nerve syndrome arise. As well as the possibility of conservative and surgical treatment.

Sequelae of surgical options in the older brachial plexus birth palsy pronation deformity / 中华显微外科杂志

ObjectiveTo evaluate the radial rotation osteotomy and ulnadouble rotation osteotomy obstetric brachial plexus injury (obstetric brachial plexus palsy) forearm pronation deformity sequelae value.MethodsFrom August 2007 to August 2011, twenty cases of obstetric brachial plexus palsy sequelae in children with forearm pronation deformity, the implementation of a simple radial rotating radial osteotomy (5cases),double-rotation radius and ulna osteotomy (15 cases) and two surgical type,and by 6 to 54 months after surgery (mean 25 months) follow-up.The groupfunctions to forearm pronation angle and conscious function improvement as the evaluation criteria. ResultsThe 15 cases of radius and ulna osteotomy in children with dual function and appearance in 14 cases significandy improved,one case of supination deformity;five underwent simple radial pronation osteotomy,three patients had improved function and appearance,followed up for 6 months, eight months after the merger which radial head dislocation in 2 cases due to poor efficacy of dual-line radius and ulna osteotomy, twenty patients in this group did not appear nonunion.ConclusionSimple radial rotation osteotomy surgery in obstetric brachial plexus palsy forearm pronation deformity complications without radial head dislocation has some value, radius and ulna double osteotomy in forearm pronation deformity with radial head dislocation aftermath of the effect is more excellent.

One-Bone Forearm Procedure for Acquired Pseudoarthrosis of the Ulna Combined with Radial Head Dislocation in a Child: A Case with 20 Years Follow-Up

This report describes a 6 year-old boy who was treated with one-bone forearm procedure for acquired pseudoarthrosis of the ulna combined with radial head dislocation after radical ulna debridement for osteomyelitis. At more than 20 years of follow-up, the patient had a nearly full range of elbow movements with a few additional surgical procedures. Pronation and supination was restricted by 45degrees, but the patient had near-normal elbow and hand functions without the restriction of any daily living activity. This case shows that one-bone forearm formation is a reasonable option for forearm stability in longstanding pseudoarthrosis of the ulna with radial head dislocation in a child.

One-Bone Forearm Procedure for Acquired Pseudoarthrosis of the Ulna Combined with Radial Head Dislocation in a Child: A Case with 20 Years Follow-Up

This report describes a 6 year-old boy who was treated with one-bone forearm procedure for acquired pseudoarthrosis of the ulna combined with radial head dislocation after radical ulna debridement for osteomyelitis. At more than 20 years of follow-up, the patient had a nearly full range of elbow movements with a few additional surgical procedures. Pronation and supination was restricted by 45degrees, but the patient had near-normal elbow and hand functions without the restriction of any daily living activity. This case shows that one-bone forearm formation is a reasonable option for forearm stability in longstanding pseudoarthrosis of the ulna with radial head dislocation in a child.

Clinical and Radiological Manifestations of Osteogenesis Imperfecta Type V

We reviewed clinical manifestation of 12 patients from three Korean families. They showed mild to moderate bone fragility, and suggested an autosomal dominant inheritance pattern. Significant intrafamilial phenotype variability was obvious. Clinical, radiological, and histopathologic characteristics that distinguished this subtype from others include ossification of interosseous membrane of the forearm with radial head dislocation, hyperplastic callus formation, no evidence of type I collagenopathy and an abnormal histopathologic pattern. Severity of the interosseous membrane ossification was correlated with increasing age (p<0.01) and the radial head dislocation was thought to be a developmental problem rather than a congenital problem. Four children who had bisphosphonate treatment showed improved bone mineral density, radiological changes, and biochemical responses. Osteogenesis imperfecta type V was a distinctive subtype of osteogenesis imperfecta, which caused mild to moderate disability clinically.

Clinical Experience of the Ilizarov Application for Correction of Ulnar Defect with a Dislocated Radial Head: 2 Cases report / 대한정형외과학회잡지

2 patients of forearm deformities with ulnar defect and radial head dislocation were treated with the Ilizarov apparatus at Chungnam University Hospital. One patient had a severe hypoplastic remnant-like ulnar fragment and a anterolaterally dislocated radial head due to complicated osteomyelitis of ulnar. We applied an Ilizarov apparatus to transport the radial head distally, and fixed to remaining proximal ulnar fragment. The other had a large bony defect at the ulnar shaft and a dislocated radial head due to complicated osteomyelitis of ulna. We performed internal transport of ulna to decreased the ulnar defect and to descend the dislocated radial head. The clinical-radiological features and functional results of those 2 forearm deformities were described with brief review of the articles about the Ilizarov method for correction of forearm defor- mities.

Traumatic Bowing of the Ulna with the Dislocation of the Radial Head: Report of a Case / 대한정형외과학회잡지

Although traumatic bowing of one or both bones of the forearm in children following acute trauma was reported by some authors, traumatic bowing of the ulna with dislocation of the radial head was described by only a few reports. We experienced one case of traumatic bowing of ulna associated with dislocation of the radial head and it was managed with open reduction of the dislocation of radial head and closed management of the bowing of the ulna. The result 1 year 10 months after treatment was very good, so we report this a case with related literatures.