Luxación crónica de la cabeza radial, una modificacion a la técnica de Bell Tawse

García-Pinto, Guillermo; Redon-Tavera, Antonio
January 2010
Revista de Sanidad Militar;jan/feb2010, Vol. 64 Issue 1, p7
Academic Journal
The anterior traumatic dislocation of the radial head usually torn annular ligament and the capsular joint, some times comes with ulnae or distal radial fracture. If we recognize the dislocation in the early stage (the first month) we can fixed with a conservative management with great results. The treatment of the chronic dislocation is very controversial and the opinions differ; the clasical procedure of Bell Tawse is to take a long portion of the triceps tendon as long as 6 cms, and take it around the radial head and holding the ulna in a bone bridge and so then reconstruction of the annular ligament, is the most accepted surgical procedure with radial and ulnar osteotomy, unlucky, we found ourself with two patients with a very short and wide triceps tendon, so we decide to make a modification to the original surgical procedure. Description of the surgical procedure: Place the patient prone on the operating table, with the arm abducted 90°, and the flex the elbow, we make a Boyd incision, move lateral the anconeus muscle and identify the capsular joint, usually is folded in two layers and lateral, because the anterior portion is torn, you make a vertical incision and remove the rest of the capsular joints and the annular ligament, with our thumb we reduce the radial head gently, then we identify the triceps tendon and separated it from the muscle portion, split longitudinal in two, we have two portions of 4 cms each, we have to be very careful to not dissected from the olecranon, each portion of the annular tendon is hold it with a Bunell, we leave free the portions, suture most be non absorbable, we make a perforation thought the ulnar bone and we past the medial portion of the annular tendon around the anterior portion of the radial head, the lateral portion pass thought the posterior portion of the radial head, portions are hold together on the lateral side and make a knot making good tension. After six months our patients has a good function of the radial head.



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