Excision of the radial head in patients younger than 18 years.

We evaluated the results of an excision of the radial head in 25 patients (27 operated-on elbows) younger than 18 years with stiff painful radiocapitellar joints. The mean age was 14.2 years (range, 4.6-17.8 years) with average follow-up of 7.8 years. Analysis of the results with a postoperative elbow score revealed excellent or good results in 19 of the 27 elbows of patients. Skeletal maturity of the patient did not alter the results based on the rating scale. Revision surgery to remove appositional bone growth was needed in six of the 12 posttraumatic cases and one of 15 developmental elbows. Cubitus valgus, wrist pain, and ulnar neuropathy were not clinical problems at follow-up examination. Excision of the radial head was beneficial for 70% of patients younger than 18 years with stiff, painful radiocapitellar joints. Results were not improved in patients who had reached skeletal maturity.

Long-term followup of Bankart reconstruction. Incidence of late degenerative glenohumeral arthrosis.

We identified 52 patients (56 shoulders) who underwent Bankart reconstructions for recurrent anterior instability between 1970 and 1983. We wanted to determine the prevalence of late degenerative arthrosis of the glenohumeral joint. Thirty-one patients (33 shoulders) returned for evaluation consisting of a questionnaire, physical examination, and radiographs, at an average 15-year followup. A true anteroposterior view and an axillary lateral view of both shoulders were obtained to identify signs of glenohumeral degenerative disease. The Bankart rating score devised by Rowe et al. was used to determine the subjective and objective outcome. The average Bankart score was 84. Average restriction of external rotation was 18 degrees with the arm at the side and 15 degrees with the arm abducted 90 degrees. Radiographic evaluation showed that 13 operated shoulders had normal radiographs, 14 had minimal degenerative changes, 3 had moderate changes, and 1 had severe changes. The patient with severe degenerative changes had marked restriction of external rotation of his operated shoulder. Statistical analysis using Spearman correlation coefficients revealed that there was a relationship between degenerative radiographic changes and restriction of external rotation with the arm abducted 90 degrees and length of followup, although correlations were limited because of the small number of patients with degenerative changes.