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.

Dorsal Angulation after Proximal Dome Osteotomy for Hallux Valgus / 대한족부족관절학회지

PURPOSE: We try to retrospectively evaluated the amount of dorsal angulation angle of the first metatarsal commonly occurring as the complication of proximal dome osteotomy for hallux valgus. MATERIALS AND METHODS: Between January 2004 and March 2004, 34 patients who underwent proximal dome osteotomy for moderate to severe hallux valgus. Two of 34 patients were male, and thirty-two were female. The average age was 57.6 years. We measured and compared hallux valgus angle, 1st-2nd intermetatarsal angle, dorsal angulation angle of 1st metatarsal on preoperative, postoperative, postoperative 3 weeks', postoperative 3 months' X-ray. RESULTS: Osteotomy sites were completely united on plane X-ray in all cases. The hallux valgus angle averaged 41.2 degrees (30~60 degrees) at preoperative, 4.3 degrees (-10~20 degrees) at postoperative, 5.5 degrees (-1~20 degrees) at 3 weeks after operation, 7.8 degrees (-2~20 degrees) at 3 months after operation. The 1st-2nd intermetatarsal angle averaged 17.1 degrees (12~24 degrees) at preoperative, 6.3 degrees (0~13 degrees) at postoperative, 7.2 degrees (0~15 degrees) at 3 weeks after operation, 8.7 degrees (0~18 degrees) at 3 months after operation. The dorsal angulation angle averaged 0.4 degrees (0~3 degrees) at postoperative, 1.6 degrees (0~7 degrees) at 3 weeks after operation, 2.1 degrees (0~8 degrees) at 3 months after operation. There were no statistically correlation between increase of dorsal angulation angle of the distal segment of the first metatarsal and increase of hallux valgus angle or 1st-2nd intermetatarsal angle. CONCLUSION: Our results shows that the dorsal angulation of distal fragment occurring after the proximal dome osteotomy in the treatment of hallux valgus may be minimized with meticulous surgery and patient's education.