POSTTRAUMATIC ELBOW DEFORMITIES IN CHILDR EN

In the last 20 years 49 children with gross posttraumatic elbow deform ities have been treated in our hospital: 19 patients with an overlooke d radial head dislocation, 12 children with a radial condyle deformity and 19 patients with a severe radial head deformity. Secondary treatm ent: In the majority of cases secondary surgical procedures led to uns atisfying results. Only 4 patients with a pseudarthrosis of the radial condyle were treated secondarily. Surgical fixation led to good funct ional results but was not able to remove the joint deformity. Overlook ed radial head dislocations were treated by ulnar osteotomy in 17 case s. We were able to follow up 13 of these: a redislocation had taken pl ace in 8 of them. Functional impairment was found in 6 redislocated ca ses and in 2 children with a correct position of the radial head. In p atients with gross radial head deformities arthrolysis was performed. The radial head had to be taken out in 7 cases. Functional results of pro-and supination were unsatisfactory. Initial treatment and causes: Persistent dislocations of the radial head had been overlooked initial ly. In 9 out of 12 cases with a radial condyle deformity a conservativ ely treated dislocated fracture had led to a pseudarthrosis. In the re maining 2 cases the fracture fragments had been fixated in an incorrec t position. Radial head deformities were seen after dislocated radial head fractures which had been treated by open reduction, internal fixa tion, longterm immobilization (6-8 weeks) and excessive physiotherapy. Conclusion: In 47 out of 49 cases posttraumatic deformities were eith er caused by delayed an neglected treatment or traumatic and excessive therapy methods. An adequate initial diagnosis and therapy can preven t more than 90% of severe posttraumatic elbow deformities in children.