Management of chronic radial head dislocation associated with segment bone defect in ulna after osteomyelitis.

BACKGROUND: We report our treatment for chronic radial head dislocation associated with segment bone defect and shortening in ulna after osteomyelitis, using bone transport with a unilateral external fixator.

METHODS: Between October 1994 and January 2009, 10 patients with chronic radial head dislocation associated with bone defect and shortening in ulna caused by osteomyelitis underwent bone transport using a unilateral external fixator in our unit. There were six males and four females, with a mean age of 14.2 years (range, 10-17 years). The mean ulna defect measured as the discrepancy between the length of the radius and the ulna was 5.4 cm (range, 3.5-7.8 cm).

RESULTS: In a mean follow-up of 78 months (range, 27-132 months), all patients had achieved bony union and complete reduction of the radial head. All patients were satisfied with the cosmetic appearance of the elbow and the length of the upper extremity. The mean arc of flexion-extension was improved by 26.5 degrees (from preoperative 96.5 degrees to postoperative 123.0 degrees) and the mean arc of supination-pronation was improved by 48.5 degrees (from preoperative 86.5 degrees to postoperative 135.0 degrees). The mean bone healing index was 40.5 d/cm (range, 35-47 d/cm). The mean ulnar lengthening was 5.2 cm (range, 3.5-7.5 cm).

CONCLUSION: Although it is time consuming, bone transport is a therapeutic alternative for chronic dislocation of the radial head associated with bone defect and shortening in ulna.

LEVEL OF EVIDENCE: Therapeutic study, level V.