Sheth Binoti, Desai Keyur B, Jain Kamal, Pawar Pankaj
Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India.
J Orthop Case Rep. 2022 Dec;12(12):30-34. doi: 10.13107/jocr.2022.v12.i12.3452.
Isolated anteromedial radial head dislocations are rare and are infrequently associated with hidden musculotendinous sling of superficial brachialis or biceps tendon impeding closed reduction. Failure to identify this impeding tendon can lead an unsuccessful and unstable open reduction surgery. This is the first case of its kind where the delayed presenting patient was treated without resection of the tendon.
We describe a case of an irreducible neglected isolated anteromedial radial head dislocation in a 7-year-old male child presenting 2 months following injury with features of active heterotrophic ossification (HO). Open surgical exploration 4 months following the injury through the Boyd's approach revealed a hidden musculotendinous sling of superficial brachialis suspending the radial head anteromedially. Releasing the adhesions and relocation of the tendon allowed spontaneous radiocapitellar joint reduction. The joint congruency was maintained at 18 months and the functional outcome was excellent with a mild flexion-pronation deficit.
Awareness of the rare impeding biceps/brachialis tendinous sling in cases of isolated anteromedial radial head dislocation can guide the surgeon to order an indicated preoperative magnetic resonance imaging and plan an early open reduction. HO may occur frequently with such an injury considering the severity of the associated soft-tissue injury.
孤立性桡骨头前内侧脱位较为罕见，很少与阻碍闭合复位的肱肌或肱二头肌肌腱隐蔽性肌肌腱吊带相关。未能识别这种阻碍肌腱会导致切开复位手术失败且不稳定。这是首例对延迟就诊患者未切除肌腱进行治疗的此类病例。
我们描述了一名7岁男性儿童的病例，其因受伤2个月后出现活跃性异位骨化（HO）特征而出现不可复位的被忽视的孤立性桡骨头前内侧脱位。受伤4个月后通过博伊德入路进行的开放手术探查发现，肱肌的隐蔽性肌肌腱吊带将桡骨头悬吊在前内侧。松解粘连并重新定位肌腱后，桡尺关节自发复位。18个月时关节一致性得以维持，功能结果极佳，仅存在轻度的屈曲旋前功能障碍。
在孤立性桡骨头前内侧脱位病例中，认识到罕见的阻碍性肱二头肌/肱肌肌腱吊带可指导外科医生安排必要的术前磁共振成像检查并规划早期切开复位。考虑到相关软组织损伤的严重程度，此类损伤可能经常发生HO。
