At that point, the radial head was found to sublux during supination and pronation. To be able to distract the osteotomy, we applied a mini rail external fixator to the ulna and proceeded to perform a proximal ulnar osteotomy. The radial head could only be partially reduced, so we had to perform a proximal ulnar osteotomy. Initially, the humeroradial joint was cleared of scar tissue and of the remains of the annular ligament. A posterolateral Boyd’s approach was utilized. The patient was taken to the operating theater and an above elbow tourniquet was placed. For these reasons, it was decided to try to reduce the radial head. Parents were also concerned about serious limitations in elbow range of motion. The patient’s main complaint was the difficulty of extending his thumb. (a and b) Initial (a) anteroposterior and (b) lateral radiographs of the left elbow revealing an anterior dislocation of the radial head. However, there were no intra-articular fragments. A computed tomography scan of the left elbow was performed to determine if there were any bony fragments in the joint. We concluded that the patient had most probably suffered a Monteggia Bado type I fracture which had been missed and therefore gone untreated. The anteroposterior and lateral radiographs of the left elbow showed an anterior dislocation of the radial head ( Fig. His Mayo Elbow Performance Score was poor (55/100). Specifically, the patient presented: 90° flexion, 70° pronation, 20° loss in extension, and almost no supination. Clinical examination revealed difficulty to flex and inability to rotate his left elbow. Unfortunately, the patient had come from another country and had no previous radiographs. There was a history of an injury to his left forearm 9 months ago, which was initially treated conservatively. In August 2016, a 10-year-old boy presented to the orthopedic outpatient clinic of our hospital, complaining of limited range of motion of the left elbow as well as difficulty in extending the left thumb.
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