Congenital Versus Isolated Traumatic Radial Head Dislocation in Adults: A Diagnostic Dilemma With an Algorithmic Approach.

Congenital radial head dislocation (CRHD) is a rare elbow condition that often remains undiagnosed until adulthood due to its asymptomatic nature. In contrast, isolated traumatic radial head dislocation (TRHD) is another uncommon entity that results from an elbow injury. Given their rarity and overlapping clinical features, distinguishing CRHD from isolated TRHD, particularly in adults with a history of trauma, poses a significant diagnostic dilemma. This review aims to enhance awareness about both conditions, and it is the first to address an in-depth comparison. A novel dual-algorithm approach is proposed as well to overcome the diagnostic challenges and guide clinicians' decisions. PubMed and Scopus were searched to identify reported cases of CRHD and isolated TRHD in adults. Key aspects, including epidemiology, clinical presentation, diagnostic modalities, and treatment strategies, were analyzed. Two diagnostic algorithms were developed based on clinical and radiographic parameters. CRHD is often asymptomatic until adulthood, typically lacks a history of trauma, shows bilateral involvement, and is frequently associated with congenital abnormalities. Conversely, isolated TRHD presents acutely with pain and a restricted range of motion (ROM) post-trauma. Imaging findings are crucial to differentiate the former two entities. Treatment differs significantly; CRHD is typically managed conservatively unless symptomatic, while isolated TRHD often requires closed reduction, with surgery reserved for irreducible cases or instability. CRHD and isolated TRHD in adults are exceptionally rare, and differentiation is crucial for proper management. This review highlights the diagnostic challenges of CRHD first identified in adulthood and emphasizes the value of clinical suspicion, imaging, and individualized treatment planning. Finally, the dual-algorithm approach provides the first structured diagnostic model to assist differential diagnosis of CRHD and isolated TRHD in adults, offering a cost-effective pathway and a more comprehensive option when initial evaluation is inconclusive.