Kawoosa et al. Journal of Medical Case Reports 2010, 4:344 http://www.jmedicalcasereports.com/content/4/1/344 osteogenesis, we were able to relocate the radial head gra- dually. Our follow-up supports the view that distraction lengthening and hyperangulation in different planes may obviate the need for open reduction and annular ligament reconstruction. Case presentation Our first patient was a four-year-old Kashmiri boy, who had pain and deformity of the right elbow. The child had received trauma to the elbow six months previously. On physical examination, a prominent radial head and mild limitation of supination and pronation were seen. Our second patient was a six-year-old Kashmiri boy. He had a history of elbow trauma one year previously, for which he had not received any treatment at the time. In both cases, an anterolateral dislocation of the radial head was confirmed by radiography. An underlying ulnar injury in both our cases was suspected because of the loss of proximal convexity of ulna (Figure 1).We chose a procedure (the Ilizarov technique) that would produce controlled lengthening and hyperangulation in two planes to restore the radiocapitellar articulation without open reduction and reconstruction of annular ligament. The procedure was explained to both sets of Page 2 of 6 parents and written informed consent obtained from them. Approval from the institutional ethics board was also obtained. Radiographs in both anterio-posterior and lateral view were studied to assess the dislocation of the radial head. Because the dislocation in both of our patients was an anterolateral one (Figures 1, 2), an osteotomy in the proximal ulna and differential lengthening in two planes was planned to create a medial (Figure 3) and posterior (Figure 4) hyperangulation, to place the radial head in the appropriate radiocapitellar orientation. We hoped to avoid open reduction of the dislocation and reconstruc- tion of the annular ligament. The surgery was undertaken under general anesthesia. A two-ring construct with hinge application was used. The ring was fixed only to the ulna, to allow free supi- nation and pronation movement. The proximal ring was fixed with an Ilizarov wire and one half-pin. The distal ring was fixed by two half-pins in different planes on the subcutaneous border. Through an incision 15 mm long, a low-energy corticotomy of the ulna was per- formed at the proposed site (Figure 5). We did not make any attempt to hyperangulate the ostotomy intrao- peratively. Distraction was started on the seventh day Figure 1 Preoperative radiograph of patient 1 showing Monteggia fracture dislocation (Patient 1). Figure 2 Preoperative radiograph showing radial head dislocation (Patient 2).