Congenital radial head dislocation

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Classification according to ICD-10
Q68.8 Other specified congenital musculoskeletal deformities
ICD-10 online (WHO version 2019)
Congenital radial head dislocation in a two-year-old girl in the anterior and lateral radiograph. The proximal end of the radius does not point to the bone core of the humeral capitulum. In addition, there is sclerosis of the proximal radioulnar joint, which is to be interpreted as an indication of a synostosis .

The congenital radial head dislocation (also congenital elbow dislocation; English Congenital radial head dislocation; Congenital elbow dislocation ) is the most common congenital malformation of the elbow joint and describes a dislocated position of the radial head .

The first description was probably made by Guillaume Dupuytren and Loir in 1830. In the English-speaking world, the publication by Smith (1852) is called the first description.

The disease is not to be confused with subluxation of the radial head (pronatio).

distribution

The frequency is given as 2 - 4 in 1,000, the male gender is more often affected. It is considered less common than overlooked Monteggia lesions.

root cause

The etiology has not yet been clarified; an autosomal dominant mode of inheritance is suspected, particularly in the case of dorsal dislocation.

pathology

There is a malformation of the elbow with flattening of the humeral capitulum, deformation and dislocation of the radial head and restricted movement of the elbow joint.

The dislocation usually takes place dorsally. The original disturbance is probably due to the formation of the humeral capitulum with a subsequent misalignment of the humero-radial joint.

Malformations and systemic diseases with dislocation of the radial head

Syndromes with possible radial head dislocation

Clinical manifestations

Clinical criteria are:

  • No or only minor discomfort or movement restrictions , only limited supination and pronation
  • Often on both sides
  • Valgus position in the elbow

Diagnosis

The diagnosis usually results from the X-ray image , sonography and magnetic resonance tomography can document further details.

Differential diagnosis

In the case of unilateral dislocation, especially anteriorly, it is very difficult to differentiate from an acquired dislocation. According to McFarland, the following criteria speak for a congenital dislocation:

  • Hypoplasia or absence of the humeral capitulum
  • Difference in length of the forearm bones
  • convex curvature, lengthening and narrowing of the radial head
  • concave shape of the ulna to the radial head
  • Hypoplasia of the trochlea with a prominent ulnar epicondyle

therapy

Treatment is often not necessary because of the minor functional impairment. Surgical interventions can be considered if there is a significant difference in length of the forearm bones or if the radial head protrudes.

literature

  • KF Kuminack, K. Reising, L. Schwering, NP Südkamp, ​​PC Strohm: Congenital radial head dislocation on both sides. In: The trauma surgeon. Volume 110, Number 2, February 2007, pp. 171-175, doi: 10.1007 / s00113-006-1158-6 , PMID 17058062 .
  • K. Sachar, AD Mih: Congenital radial head dislocations. In: Hand clinics. Volume 14, Number 1, February 1998, pp. 39-47, PMID 9526155 (review).

Individual evidence

  1. a b c d F. Hefti: Pediatric orthopedics in practice. Springer 1998, ISBN 3-540-61480-X , p. 479.
  2. G. Dupuytren: Leçons orales de clinique chirurgicale faites à l'Hôtel-Dieu de Paris ... , Vol. 4 In: Soc. Encyclographique des Sciences Médicales , 1839, p. 137
  3. ^ RW Smith: Congenital luxation of the radius. In: Dublin Journal of Medical Science , Vol. 13, 1852, pp. 208-210
  4. a b c d C. J. Wirth, L. Zichner, AK Martini: Orthopedics and Orthopedic Surgery. In: W. Winkelmann (editor): Tumors, tumor-like diseases , Georg Thieme Verlag, 2003, ISBN 3-13-126181-1
  5. a b Radiopaedia
  6. ^ B. McFarland: Congenital dislocation of the head of the radius. In: British Journal of Surgery. 24, 1936, p. 41, doi: 10.1002 / bjs.1800249306 .

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