Radial head dislocation in children with cerebral palsy

Dislocation of the radial head in children with cerebral palsy (CP) is rarely reported, and the incidence of the condition is unknown. The authors present the treatment and outcome of 10 painful radial head dislocations in eight children with spastic quadriplegic-pattern CP treated over a 21-year period. Four patients were managed by open reduction of the radial head and reconstruction of the annular ligament, and four were managed by radial head excision followed by early motion. All of the patients who underwent reconstructive surgery suffered redislocation within 16 weeks of the procedure, with a return of pain and contracture of the elbow at subsequent follow-up. All four patients who underwent excision of the radial head remained pain-free, with improved elbow motion, at a follow-up of 4 years 4 months. The authors believe that once symptomatic radial head dislocation is established in CP patients, excision of the radial head gives a better final outcome than reconstructive procedures.