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How to treat old elbow dislocation in a child?

Q: My daughter, 7 years old now, had a left elbow dislocation 4-1/2 years back. After treatment,it was found that the bone had not been set properly in the elbow socket. The doctor advised us not to go in for surgery but to wait till the child was 6-7 years old before taking a decision. What treatment do we undertake now to set the elbow bone back in the socket? Is surgery the only way out; if so how major is the surgery involved? My daughter is able to do all activities with her hands and is even able to swing on the monkey bars effectively without any pain in her hands or elbows. In fact she prefers to be only on monkey bars swinging all the time. She is interested in playing games like tennis and this is causing concern as it requires use of left arm to support a backhand shot or falling, which I fear may cause severe stress and strain to her left elbow. Please advise what should be our next step to getting my daughter completely alright and free of this handicap. Thanks so much.

A:Couple of things which are striking are: your daughter's ability to do all activities and even something bizarre like continuous bar swinging under the circumstances!; and involvement of left elbow (your daughter being right handed). Elbow is a delicate joint and surgery around this region can have some controversial results. Old unreduced elbow dislocation which is asymptomatic and hasn't fortunately resulted in any stiffness, I feel, is best left alone. Playing tennis with the right hand should not have any untoward effect on the left elbow. Having stated all of the above, surgery at present would only aim at restoring stability and contour of the joint without any guarantee of preserving the same range of motion as it was before surgery. A future elbow replacement if required, would apparently be easier after this surgery. Articles are there supporting this. However the final decision on remanagement would be best taken after clinical & radiological assessment of your daughters elbow.

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