Working Diagnosis:
Bilateral radial head dislocations

Treatment:
After orthopedic consultation, surgical treatment was not recommended at that time. Therefore, a conservative approach was pursued with observation, lifestyle modifications, and over the counter anti-inflammatory medications for flare ups of pain.

Outcome:
After telephone follow up, the patient reports doing fairly well without surgery. He has been able to maintain his physical activity, but continues to have occasional flare ups of pain which ar controlled with over the counter anti-inflammatory medicines.

Author's Comments:
Both the orthopedist and myself agree this is a congenital bilateral radial head dislocation abnormality. There is not enough literature to support performing an elbow surgery, such as a radial head osteotomy, to try and improve pain or range of motion with this condition. The literature shows that the natural history of this condition to be benign.

Editor's Comments:
Dispositon of this well-known condition is important. Most patients do well with conservative care. However, osteoarthritis may develop and is seen more commonly in posterior (compared to anterior) dislocations, and some of these do require radial head excision.

References:
1. Agnew DK. Congenital Unilateral Dislocation of the Radial Head. J Pediatr Orthop. 1993 Jul; 13(4): 526-8.
2. Almquist EE, Gordon LH, Blue Al. Congenital Dislocation of the Head of the Radius. J Bone Joint Surg Am. 1969 Sep; 51(6): 1118-27.
3. Campbell CC, Walters PM, Emans JB. Excision of the Radial Head for Congenital Dislocations. J Bone Joint Surg Am. 1992 Jun; 74(5): 726-33
4. Echtler B. Isolated Congenital Dislocation of the Radial Head. Acta Orthop Scand. 1997 Dec; 68(6):598-600.
5. Carcia-Alverez G, Morales J, Maria Luisa Bello Ml. Congenital Dislocation of the Radial Head: Avoiding Post-Traumatic Misdiagnosis. International Pediatrics. 2002: 17(2): 107-109.
6. Hoger PH, Henschel MG. Skeletal Anomalies in Nail-Patella Syndrome. Case Report and Overview. Hautarzt. 1997 Aug; 48(8): 581-5.
7. Kelly DW. Congenital Dislocation of the Radial Head: Spectrum and Natural History. J Pediatr Orthop. 1981: 1(3): 295-8.
8. Kosay C. Congenital Anterior Dislocation of the Radial Head. Eur J Radiol. 2002 Jul; 43(1): 57-60.
9. Kuminack KF. Congenital Radial Head Dislocation on Both Sides. Unfallchirurg. 2007 Feb; 110(2): 171-5.
10. McFarland EG, Gill HS, Laporte DM, Streiff M. Miscellaneous Conditions about the Elbow in Athletes. Clin Sports Med. 2004 Oct; 23(4): 743-63.
11. Reichenbach H, Hormann D, Theile H. Hereditary Congenital Posterior Dislocation of Radial Heads. Am J Med Genet. 1995 Jan; 55(1): 101-4
12. Sacher K, Mih AD. Congenital Radial Head Dislocations. Hand Clin. 1998 Feb; 14(1): 39-47.

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