Guidelines for managing posterior elbow dislocations: Lessons to be learnt

Abstract

A 62-year-old lady fell onto her out-stretched rightarm and presented to accident and emergency witha posterior dislocation of her right elbow and anundisplaced radial head fracture. The dislocationwas reduced and an above elbow back-slab applied.Post-manipulationradiographsconfirmed asatisfac-tory reduction. She represented to accident andemergency 2 days later with increased pain in herright elbow and the sensation that her elbow hadmoved. No X-ray was requested and the back-slabwas changed to a wool and crepe bandage.One week later, at fracture clinic, the lady wasexaminedandnotedtohaveapainful bruisedelbowwith a limited range of motion (flexion 30—908 andsupination and pronation to 458). No X-ray wasperformed and the lady was advised to start gentleelbow mobilisation. Two weeks later the symptomsand findings remained unchanged. Again, no radio-graphs were requested and the patient was dis-charged to physiotherapy.Thepatientwasre-referred3monthslater,totheseniorauthor,withanarcofmovementof308andnoimprovement in the range of movement. At thistime, examination revealed an incongruent elbowand X-rays confirmed a chronic posterior elbowdislocation and heterotropic ossification (Fig. 1).The lady then underwent elective open reductionusing a posterior, triceps elevating approach, exci-sionoftheheterotropicboneanddistractionarthro-lysis using the Stryker Dynamic Joint Distracter(Fig. 2).Immediate post-operative mobilisation of theelbow was commenced and the external fixator