Treatment of neglected ulnar longitudinal deficiency associated with radial head dislocation in a 9-yr old male patient. Case-study and review of the current literature

Abstract

Ulnar longitudinal deficiency represents a challenging clinical entity in terms of treatment and functional recovery.

Case study

 A 9-year old male patient was referred to our outpatient clinic due to severe shortening and ulnar deviation of his right upper limb. Range of motion of the elbow joint was limited including both flexion-extension and pronation-supination.  Radiographic examination revealed absence of the distal two thirds of the ulna as well as bowing of the radius and dislocation of the radial head. The patient underwent surgical treatment involving excision of the fibrocartilaginous anlage extending between the proximal ulna and the carpus, excision of the proximal radius and creation of a single-bone forearm in neutral rotational position.  

Results

At 6 weeks postoperatively bone healing at the site of the fusion was achieved. In terms of functional results, flexion and extension of the forearm were comparable to the contralateral extremity.

Conclusion

Creation of a single-bone forearm represents a viable treatment option in cases of ulnar longitudinal deficiency associated with radial head dislocation and limited pronation – supination of the forearm. Surgical intervention should be encouraged early so as to prevent deformation of the radius.