Traumatic Divergent Elbow Dislocation in an Adult with an Associated Fracture of the Distal Part of the Humeral Shaft and an Open Perilunate Dislocation: A Case Report.

Abstract

Divergent dislocation of the elbow represents an extremely rare injury. The proximal radioulnar joint is disrupted as the distal part of the humerus is driven between the radius and ulna, and the forearm dislocates posteriorly. We believe that DeLee, in 1981, reported the first modern case of divergent elbow dislocation that was confirmed by radiographs in a child1. Subsequently, to the best of our knowledge, there have been twenty-one additional reported cases of divergent elbow dislocation in children2-19. We identified only one previously published case report of traumatic divergent elbow dislocation in an adult20. We present an adult patient with a traumatic divergent dislocation of the elbow with an associated humeral fracture and an open perilunate dislocation. The patient was informed that data concerning the case would be submitted for publication, and he provided consent; the institutional review board approved the submission. ### Initial Patient Presentation A twenty-nine-year-old right-hand-dominant man presented to our emergency department after landing on the outstretched left upper extremity following a 15-foot fall from a ladder. Initial physical examination of the extremity revealed gross deformity of the midhumerus and swelling of the left elbow. A 2-cm wound over the lateral part of the elbow communicated with the radiocapitellar joint. Carpal bones were extruded through a second wound over the volar aspect of the wrist on the same extremity. The patient’s hand was well-perfused with palpable pulses. He reported paresthesias in the median nerve distribution. Radiographs demonstrated a displaced mid-diaphyseal humeral fracture and an open divergent elbow dislocation (Figs. 1-A and 1-B). Distally, the patient had an open trans-scaphoid perilunate dislocation, fracture of the trapezium, and left fourth and fifth metacarpal fractures (Figs. 2-A and 2-B). Additional injuries included fractures of the lumbar transverse processes, ribs, superior and inferior pubic rami, iliac wing, …