Congenital Radial Head Dislocation: A Narrative Review of Etiology, Diagnosis, and Treatment

Summary

Congenital radial head dislocation (CRHD) is a recognized congenital anomaly of the elbow that may present late due to subtle symptoms and diagnostic challenges. Diagnosis relies on clinical and imaging findings, while treatment ranges from observation to surgery, depending on symptoms and functional impairment.

Abstract

Congenital radial head dislocation (CRHD) is an uncommon orthopedic anomaly affecting the elbow joint and is frequently associated with other congenital deformities. This narrative review synthesizes evidence identified through targeted searches of PubMed and Web of Science, with emphasis on peer-reviewed studies addressing the epidemiology, developmental and genetic mechanisms, diagnostic evaluation, clinical differentiation, management strategies, and treatment outcomes of CRHD. CRHD may present as either unilateral or bilateral dislocation, with posterior dislocation being the most frequently reported subtype. Frequently overlooked during childhood, CRHD often becomes clinically apparent during adolescence or adulthood through symptoms such as elbow discomfort, cosmetic prominence, mechanical symptoms, and restricted joint mobility. Diagnosis remains challenging because of its variable clinical presentation and often requires careful integration of clinical history, physical examination, and imaging findings. The pathogenesis of CRHD is multifactorial and involves complex genetic, developmental, and structural abnormalities, particularly collagen type I defects, disturbances in endochondral ossification, and disproportionate growth between the ulna and radius. Management strategies range from conservative observation in asymptomatic or minimally symptomatic patients to surgical interventions, including radial head excision, ulnar osteotomy, open reduction, and annular ligament reconstruction in selected symptomatic cases. Although surgery may provide pain relief and improve forearm rotation, it carries potential complications, including wrist pain, recurrent deformity, and redislocation. Further research is needed to refine diagnostic criteria, optimize patient selection for surgery, and improve long-term functional outcomes in patients with CRHD.

Introduction

Radial head dislocation is an uncommon condition that may be congenital or acquired. Acquired dislocations are most frequently associated with trauma, particularly neglected or chronic Monteggia fracture-dislocations. In contrast, congenital radial head dislocation (CRHD) is a rare developmental abnormality and represents the most common congenital disorder of the elbow joint. Despite its rarity, CRHD remains an important diagnostic consideration because it is often overlooked during childhood and may not be recognized until adolescence or adulthood¹. CRHD may occur as an isolated anomaly or in association with various congenital syndromes and ....