What is Reduction of Radial Head (Elbow) Dislocation?

If a radial head dislocation is associated with deep injuries and fracture of bones, the reduction will be performed in the operating room.

The elbow is made up of the upper arm bone (humerus) and two bones in the forearm (radius and ulna). Some strong ligaments in the elbow hold all these bones in the elbow joint together.

A radial head dislocation is a rare condition that occurs when the top part (head) of the radius bone slips completely out of the elbow joint.

There are two joints in the elbow:

Humeroulnar joint: It is the joint between the ulna and humerus that allows the bending of the elbow.

Radiocapitellar joint: It is the joint between the radius and humerus that allows turning of the forearm with the palm up or down.

A radial head dislocation disturbs the radiocapitellar joint.

Dislocation of the radial head can happen due to any of the following causes:

• Traumatic: Most patients with acute radial head dislocations in the emergency department are men who have sustained a high force injury.
• Congenital (present from birth): Some patients have got a radial head dislocation from their birth.
• Underlying disease: A radial head dislocation can occur as a complication of osteomyelitis (infection of the joint).

Most of the patients who have got radial head dislocations due to trauma also have associated fractures. Usually, in such patients, a radial head dislocation happens due to significant trauma such as in motor vehicle accidents, pedestrian–motor vehicle accidents or falls from a significant height. Many times, this happens when the person falls on a fully extended forearm with the palms facing down.

Children with radial head dislocations may also have a slight deformity or fracture in the ulnar bone (Monteggia fracture).

• A person with a radial head dislocation typically holds his or her elbow bent at 90° and cannot turn his hand with palms facing up or down.
• The elbow is often swollen and tender.
• The forearm may appear shortened and deformed.

The doctor may advise for an X-ray of the affected forearm in various positions to confirm the radial head dislocation and any associated fracture.

In certain cases, computed tomography (CT) or magnetic resonance imaging (MRI) may be asked for further evaluation.

For a radial head dislocation, doctors usually advise surgery in case of adults and closed reduction in the case of children.

The reduction of dislocation is a procedure to manipulate the bones back to their normal position. If this is performed externally, that is, without opening the arm, it is known as closed reduction.

If a radial head dislocation is associated with deep injuries and fracture of bones, the reduction will be performed in the operating room with general anesthesia, which makes the patient sleep throughout the procedure. Because your arm is surgically opened for reduction, this technique is called open reduction.

The reduction of a radial head dislocation is an emergency procedure, and it generally needs to be performed within six to eight hours of injury.

• Following the reduction of a radial head dislocation, patients are generally admitted for 24 hours to observe for possible complications.
• The elbow is wrapped in a splint, made up of fiberglass or plaster, for one to two weeks depending upon the stability of the elbow joint. The splint helps in securing the radial head in its place after reduction.
• Physical therapy can be initiated once swelling and pain in the elbow disappear.
• The doctor will take frequent X-rays of the elbow to confirm the maintenance of the reduction of the dislocated radial head.