PMC4245278_01
Preoperative right elbow lateral radiograph. A radioulnar synostosis and anterior radial head dislocation are present.
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F1
Initial radiographs revealed congenital radioulnar synostosis with anterior dislocation of the radial head (Fig. 1).
MRI of the right elbow (T2 image) demonstrates fusion of the proximal one-third of the ulna and radius. Note the anterior dislocation of the radial head, joint fluid effusion, tension of anterior capsule, and edema signal in the anterior soft tissue.
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F2
TheT2-weighted sequences showed an effusion within the elbow joint and edema in the anterior soft tissues (Fig. 2).
Lateral exposure of the right elbow. The lateral collateral ligament was incised and opened. The base of the radial neck (a) had concave deformations. An annular ligament-like structure (b) overlapped the radial neck and fixed it to the anterior capsule and the lateral collateral ligament. The radial head (c) was seated on the anterior aspect of the distal humerus. A supracondylar groove was observed concave to the cartilage surface (d). While extending the elbow to 30  from full flexion, the dislocated radial head was observed to pass over the prominence of the lateral condyle (e).
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F3
Overgrowth of the radial head and a concave deformity at the base of the radial neck (Fig. 3) were observed.
Lateral exposure of the right elbow: the complete capsular repair was then removed and partial repair was performed with two stitches (a).Video, Supplemental digital content 1, http://links.lww.com/JPOB/A8: Snapping was observed during the extension from full flexion to 30 , but not during flexion from full extension. This snapping was no longer observed following lateral release.
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F4
The complete capsular repair was then undone, and a partial repair was performed with two stitches (Fig. 4).