What are the complications and management of radial head dislocation and relocation in adults?

Complications and Management of Radial Head Dislocation and Relocation in Adults

Radial head dislocations in adults can lead to significant complications including joint instability, chronic pain, and functional limitations, requiring prompt diagnosis and appropriate management to prevent long-term disability.

Diagnostic Approach

• Initial evaluation should include conventional radiographs as the first imaging modality to assess for radial head dislocation and associated fractures 1
• CT imaging is recommended when radiographs are normal or indeterminate, as it provides superior identification and clarification of fracture morphology and associated injuries 1
• MRI is indicated when soft tissue injuries (ligaments, tendons) are suspected in conjunction with radial head dislocation 1

Complications of Radial Head Dislocation

Immediate Complications

• Concomitant fractures (radial head, coronoid process, olecranon) 1
• Associated ligamentous injuries, particularly to the annular ligament 1
• Joint instability and potential for recurrent dislocations 2
• Essex-Lopresti injury (concurrent dislocation of the distal radioulnar joint) 2

Long-term Complications

• Chronic pain and stiffness of the elbow joint 2
• Proximal migration of the radius (5-10mm) when support is lost at both elbow and wrist 2
• Restricted forearm rotation and decreased range of motion 3
• Post-traumatic arthritis 2
• Functional limitations affecting daily activities 4

Management Strategies

Acute Radial Head Dislocations

• Prompt reduction is essential to prevent long-term complications 2
• Assessment of associated injuries, particularly to the distal radioulnar joint 2
• Classification of fracture type guides treatment:
  • Type I: Large displaced fragments with minimal comminution - amenable to interfragmentary fixation 2
  • Type II: Severe comminution requiring radial head excision and prosthetic replacement 2
  • Type III: Old injuries with irreducible proximal migration of the radius 2

Surgical Management Options

• Open reduction with internal fixation for repairable radial head fractures 2
• Radial head prosthetic replacement for comminuted fractures 2, 4
• Combined approaches for complex injuries:
  • Ulnar osteotomy with angulation and elongation for chronic cases 3
  • Annular ligament reconstruction 3
  • Plate fixation with bone grafting when necessary 3

Post-reduction Care

• Immobilization in neutral forearm rotation for 2-4 weeks 3
• Progressive rehabilitation to restore range of motion and strength 4
• Regular follow-up to monitor for redislocation or development of complications 3

Special Considerations

• Timing of intervention is critical - excellent results are more likely when restoration of radial length is achieved within one week of injury 2
• Suboptimal outcomes are associated with delayed definitive surgery (4-10 weeks post-injury) 2
• Radial head excision alone is contraindicated in cases with distal radioulnar joint instability 2
• For chronic dislocations, both angulation and elongation of the ulna may be required to allow proper radial head reduction 3

Pitfalls to Avoid

• Failing to examine the distal radioulnar joint in all patients with radial head fractures/dislocations 2
• Performing radial head excision without addressing distal radioulnar joint instability 2
• Delaying definitive treatment, which significantly increases the risk of poor outcomes 2
• Inadequate correction of ulnar malalignment in chronic cases 3
• Overlooking associated fractures (coronoid process, olecranon) that may contribute to instability 4