Combined Posterior and Convergent Elbow Dislocations in an Adult: A Case Report and Review of the Literature

Abstract

T ranslocation of the proximal radioulnar joint, so-called convergent dislocation, is an extremely rare injury that may occur in isolation or in association with a posterior ulnohumeral dislocation. In this injury, the ulnohumeral joint is disrupted, resulting in medial translation of the radius and lateral translation of the ulna. The cases of ten patients who had convergent dislocation have been reported previously1-7. All of those patients were children. To our knowledge, there has never been a report of convergent elbow dislocation in an adult patient. Our patient was informed that data concerning the case would be submitted for publication. Figs. 1-A and 1-B The initial radiographs demonstrating posterior dislocation of the left elbow. Fig. 1-A Lateral radiograph. Fig. 1-B Anteroposterior radiograph. A moderately obese thirty-five-year-old woman sustained multiple upper extremity fractures after falling off a porch from a height of approximately four feet. She was initially evaluated at a local emergency room where physical examination and radiographs revealed a posterior elbow dislocation of the left, nondominant arm (Figs. 1-A and 1-B), an ipsilateral displaced and comminuted intra-articular distal radial fracture, and a displaced fracture of the base of the contralateral thumb metacarpal. She was subsequently transferred to our facility for definitive treatment. The patient had pain in the left wrist and elbow, with a limited range of motion, and pain in the right thumb. She had an obvious dorsal deformity of the distal part of the radius in the left arm with minimal swelling. The left elbow was held at approximately 80° of flexion, and she had a painful and limited range of motion. The right thumb was tender to palpation at the base of the metacarpal with no obvious deformity. The neurovascular examination revealed normal findings. An initial review of the radiographs revealed an obvious posterior dislocation of the …