Type I Failure of Formation
Congenital radial head dislocation is the most common congenital elbow abnormality.
Often patients are asymptomatic. When the child starts using their arm more for activities is when this condition usually gets noticed. Common symptoms are: limited elbow ROM primarily in extension and supination and activities that require forearm rotation become more difficult. Non-operative management is common if the patient is asymptomatic and the arm is functional.
Cause: The underlying abnormality is theorized to be failure of the development of a normal capitellum, causing loss of contact pressure that is required for the normal development of the radial head. The capitellum and the radial head touch to absorb some of the pressure transmitted from the wrist. With a congenital dislocating radial head, this contact pressure is lost during development. Congenital dislocating radial head is classified as Type I: Failure of Formation.
Opinions vary for the need and type of surgery required for congenital dislocating radial head. Children with elbow deformities, decreased ROM, decreased function or chronic pain are surgical candidates. With the mentioned cases, if surgery is not performed, elbow and forearm motion can become more limited, power and dexterity of the affected arm can reduce even further because of limited movement, instability and pain.
Time to Play the Brain Game:
Q) Congenital radial head dislocation is usually symptomatic and most often unilateral. True or false?
A) False – Congenital radial head dislocation is most often asymptomatic and bilateral with posterior dislocation being more common than lateral dislocations. It can be associated with Apert Syndrome.