Open postero-medial dislocation of the elbow in a 11-year old: A case report

Abstract

A 11-year-old boy was bicycling along a 6 ft highwall and fell on an extended, adducted and exter-nally rotated left arm. He walked home and pre-sented to the casualty department 1 h later. Hehad an open contaminated dislocation of his leftelbow joint (Fig. 1). There was difficulty assessingsubjectively due to anxiety, objectively he had noobvious neurovascular compromise. Radiographsrevealed a postero-medial elbow dislocation(Figs. 2 and 3).He was emergently transferred to the operatingtheatre. Surgical debridement and reduction of thejoint was performed. Intra-operative findingsshowed that the distal humerus had penetratedthrough the anterior cubital fossa. In doing so thecrucial lateral and medial collateral ligamentouscomplexes which play an important role in stabilitywere destroyed.Themediannervewasnotedtobedrapedovertheanterior aspect of the humerus but intact. Brachialartery was in continuity and protected throughoutthe procedure. The common flexor origin on themedial aspect had been displaced anteriorly.Despite almost complete disruption of the MCLand the muscular attachments, reduction was diffi-cult. The open wound was surgically extended.Reduction was achieved but there was inherentinstability and K wiring of the medial epicondylewas performed (Figs. 4 and 5).The joint was irrigated with normal saline thor-oughlyandthewoundswereclosed.Anaboveelbowback slab was applied and the patient concluded 1weekofantibiotictreatmentwithcefuroximeintra-venously.Following the procedure, examination of thechild revealed paraesthesiae in the distribution of