Introduction. The action of the radial head in the stability of the elbow is currently admitted. Its conservation is not always possible in complex fractures. The association with a posterolateral dislocation of the elbow leads to a higher risk of instability of the elbow joint and also at a longer term to degenerative changes. Some authors recommend the use of metallic radial head implant, acting as a spacer. The results seems encouraging but should the resection arthroplasty associated with the repair of the medial collateral ligament be abandoned?. Material and methods. In an amount of 35 consecutive patients who were taken in charge for an elbow dislocation 26 were included in this retrospective study, 13 of them had the association of a dislocation and a fracture of the radial head. In all 13 cases the radial head was considered as inadequate with a conservative treatment and was resected. The patients were assessed clinically according to the American Shoulder and Elbow Surgeons score (ASES) and the Mayo elbow performance index with a mean follow-up of 13 years (ranging from 5 to 15). The degenerative changes were assessed on plan × rays and an additional axial view according to the 4 stages described by Morrey. Results. No redislocation occurred. According to the Broberg/Morrey index 92% of the patients were considered as having a good result. They returned to work with no hindering. Signs of osteoarthritis grade 1 or 2 were observed and were clinically well tolerated. There was no difference for this item between the patients who conserved their radial head and those who sustained a resection. All patients were satisfied although they were protecting their joint against overuse while working. Discussion. The studies about the use of prosthesis of the radial head offer similar functional results. Degenerative changes on the trochleo ulnar joint are identical in all type of treatment. In order to prevent stiffness in the elbow joint an early post operative rehabilitation is recommended, it justifies a surgical stabilization associated with the use of an adapted dynamic splint. Conclusion. In case of elbow dislocation with a fracture of the radial head when its preservation is impossible, the resection without any prosthetic replacement remains a reasonable option if associated with a repair of the medial collateral ligament. At long term the functional results are still good with mild signs of osteoarthritis eliminating ipso facto the problem of an implant survivorship

Thirty-four acute traumatic dislocations in children aged 5 to 13 years, treated between 1994 and 2002, were reviewed retrospectively. All injuries were caused by a fall. Two injuries were compound. Two children had ulnar nerve injuries, one a radial nerve injury, and one median nerve and brachial artery injury. Posterolateral dislocations were seen in 22 children, posteromedial in eight, posterior in one, anteromedial in two and anterolateral in one. Pure dislocations occurred in eight children and 26 had associated elbow injuries, including 11 medial epicondyle, five lateral mass, one olecranon, one radial head and eight combined injuries. In the combined group, six children had associated fractures and two had divergent dislocation of the proximal radio-ulnar joint. Twenty required open reduction. The injury was initially missed in eight. The child with vascular and median nerve injury had not recovered by four months. Among the others, at follow-up of 4 to 48 months 22 results were excellent to good, 10 fair and one poor. Complications included pseudarthrosis of the medial epicondyle in one child and loss of flexion and rotation of 10° to 30° in 15. Radial and ulnar nerve injuries recovered. A high index of suspicion, good clinical examination and compared radiographs are recommended to avoid missed injuries