Posterior Dislocation Of Elbow Research Articles

"Unhappy triad" of the trauma elbow in children: Diagnosis, classification, and mid-term outcomes.

The aim of this study was to describe the epidemiology, physiopathology, and outcomes of elbow "unhappy triad" trauma in children, combining a posterior dislocation, a proximal radius fracture, and a third lesion (i.e. bony or capsuloligamentous injury). A retrospective bicentric study was conducted between 1999 and 2020. All skeletally immature children who presented to the emergency department and underwent surgery for a proximal radius injury were selected. Among this selection, only patients with two associated ipsilateral elbow injuries (i.e. posterior elbow dislocation and a bony and/or capsuloligamentous injury) were included. Active elbow ranges of motion, Mayo Elbow Performance Score and Quick-Disabilities Of The Arm, Shoulder And Hand scores and standard radiographs were recorded at last follow-up. Twenty-one patients met the inclusion criteria (mean age at surgery = 11.4 years) among 737 selected. The "unhappy triad" diagnosis was made preoperatively in nine cases (bone lesion only), intraoperatively in nine cases, and postoperatively in one case. The third lesions were surgically treated when the lesion was a bony fracture or if the elbow remains unstable between 60° and 90° of flexion (i.e. capsuloligamentous injury). Twenty patients were reviewed (mean follow-up = 5.8 years). The complications and re-operations rates were of 10%. The "unhappy" triad of the child's elbow is a rare injury, where the preoperative diagnosis is frequently missed and lead to 10% of complications and re-operations. level III.

The Unfortunate Triad of the Elbow: About 5 Cases and Review of the Literature

The unfortunate elbow triad is a severe trauma involving posterior elbow dislocation, fracture of the radial head and coronoid process. Its management is not codified in the literature. We report a retrospective series of 5 patients treated at the Traumato-Orthopedics department of the CHU Ibn Sina in Rabat, over a period of 7 months from May 2021 to December 2021, the objective being to carry out a diagnostic and therapeutic analysis. Both patients had a stable but nevertheless very painful elbow. The unfortunate elbow triad leads to bone and ligament damage threatening short- and long-term elbow stability, with a high rate of complications and random outcomes. Only the restoration of the integrity of the elbow by repairing all the structures, using a standardized surgical protocol allows good functional results.

Posterior Ulno-Humeral Dislocation with Radioulnar Shaft Fracture: Case Report and Literature Review

Background: The occurrence of radioulnar shaft fracture and elbow dislocation simultaneously is not a usual event, and it has only been reported in a few studies. This study aimed to report a case with posterior ulno-humeral joint dislocation and concomitant radioulnar shaft fracture. Furthermore, in a literature review, we summarized other studies that reported this kind of fracturedislocation and the treatment chosen in each study.
 Case Report: A 12-year-old boy was admitted to the emergency department due to high-energy trauma following a car accident while cycling. Open fracture of the left radioulnar shaft and posterior dislocation of the left elbow were detected.
 Conclusion: More studies are required to advance our knowledge about this kind of fracture-dislocation, especially its mechanism of injury. Subsequent examinations can help us design an efficient classification system and determine the best treatment option for radioulnar shaft fracture with elbow dislocation.

FUNCTIONAL OUTCOME OF NEGLECTED POSTERIOR ELBOW DISLOCATION MANAGED SURGICALLY BY OPEN REDUCTION IN A NORTH-EAST TERTIARY CENTRE OF INDIA

Introduction: Neglected posterior elbow dislocation is common in developing countries. Various treatment methods have been described. Considering the lack of facilities and cost constraints in developing countries, the treatment options are limited. The aim of the study is to evaluate the functional outcome of neglected posterior elbow dislocation managed surgically by open reduction and internal fixation with trans-olecranon Kirschner wire with or without triceps lengthening. Methods: In a retrospective study from July 2020 to June 2022, 7 patients with neglected posterior elbow dislocation were treated in our hospital with mean follow-up of 11.14 months. The Mayo Elbow Performance Index (MEPI) was used to assess subjective, objective, and functional characteristics before and after operation. Results: The mean age of 7 patients (4-males and 3-females) was 26 years. The most common mode of injury was fall with mean time interval between injury and surgery of 8.14 weeks. The mean duration of surgery was 75.71 minutes. The mean pre-operative elbow flexion was 17.86º and post-operative elbow flexion was 92.14º. The mean pre-operative elbow PS (pronation-supination) range was 17.14º and post-operative elbow PS range was 109.29º. The mean pre-operative MEPI was 5 and post-operative MEPI was 77.86. Five patients had satisfactory results (2- Excellent and 3- Good) and 2 patients had unsatisfactory results (1- Fair and 1- Poor). Conclusion: Considering all limitations in developing countries, open reduction with or without triceps lengthening followed by post-operative range of motion exercises is still the mainstay treatment to gain a functional arc of motion in the management of neglected posterior elbow dislocation.

Posterior elbow dislocation with closed ipsilateral radius and ulna fractures in provincial hospital: Case report

Posterior elbow dislocation with closed ipsilateral radius and ulna fractures in provincial hospital: Case report

Residual elbow instability in children with posterior or postero-lateral elbow dislocation.

The purpose of this study is to evaluate the incidence and the severity of residual elbow instability in children treated for posterior (PED) or postero-lateral (PLED) elbow dislocation. This retrospective study included all children younger than 14 years of age with a confirmed diagnosis of acute post-traumatic elbow dislocation (ED). Subjective data such as perceived pain, stiffness and impact of daily activities, and objective data such as skin lesions, surgical-site infections, and range of motion were recorded. All patients underwent the milking test, the chair sign test (CST) and the Drawer test (DT). The functional status has been rated according to the Mayo Elbow Performance Score (MEPS) and the Roberts criteria (RC). Radiographs of the injured arm were performed at the last follow-up visit to evaluate axial alignment, growth disturbances, osteoarthrosis, heterotopic calcifications, and the presence of loose intra-articular bodies. Nineteen patients with a mean age of 9 years and 5 months at the time of injury were available for review. Six patients had PED (31.6%) and 13 PLED (68.4%); in five cases (26.3%) the dislocation was simple and in 14 cases (73.7%) it was complex. None of the patients complained of subjective symptoms of elbow instability, although 2 patients had positive CST, and one of them also had positive milking test. RC and MEPS ranged from good to excellent in all patients. Clinical examination with multiple stability tests is important to detect residual elbow instability in children treated for ED as functional scores alone may underestimate the clinical picture.

Distal Radius Fracture with Ipsilateral Elbow Dislocation: A Rare but Challenging Injury.

Distal radius fractures are common and account for approximately 14% to 18% of all adult extremity injuries. On rare occasions, ipsilateral elbow dislocation can be observed additionally. However, this can be missed without careful examination, especially in patients experiencing altered mental status. The aim of this study was to analyze the mechanism, level of injury, demographics, and associated injuries in distal radius fracture with ipsilateral elbow dislocation. Between 2012 and 2019, we searched our trauma database for distal radius fracture with ipsilateral elbow dislocation. All patients older than 18 years old were included. Data on demographics, mechanism of injury, level of energy, and subsequent treatment were collected. A total of seven patients were identified. The mean age in this cohort was 68.7 ± 13.3 years old, and the left side was involved in 71.4% of the patients. Females were affected in 85.7% (n = 6/7) of cases, all of whom suffered from low-energy monotrauma at a mean age of 71.5 ± 12.3 years old. One male patient suffered from high-energy trauma (52 years old). Mainly, posterior elbow dislocations were observed (66.7%; n = 4/6). Distal radius fracture patterns, in accordance with the AO classification, included two C2-, two C3-, one C1-, and one B1-type fractures. In the patient suffering from high-energy trauma, the closed distal radius fracture was classified as type C3. Associated injures included open elbow dislocation, ulnar artery rupture, and damage to the flexor digitorum superficialis. Although distal radius fracture with ipsilateral elbow dislocation is thought to be from high-energy trauma, this study shows that most patients were elderly females suffering from low-energy mechanisms. It is important for clinicians to maintain a high level of suspicion for any concomitant injury in this population.

Surgical management of a traumatic elbow dislocation with disruption of the brachial artery

Abstract Background Dislocations of the elbow are the second most common dislocations of humeral joints following the shoulder. Besides numerous possible concomitant injuries of the collateral ligaments or the extensor or flexor apparatus, an accompanying disruption of the brachial artery is a rare occurrence. In the following, such a case is presented and discussed. Method A 70-year-old woman sustained a closed posterior elbow dislocation with accompanying disruption of the brachial artery due to a fall in a domestic environment. Pulselessness of the radial artery led to a computed tomography angiography being performed, which confirmed the diagnosis. Direct operative vascular reconstruction with a vein insert was carried out. Due to strong swelling of the soft tissue, other examinations of the elbow could not be performed initially. A redislocation a few days later led to an operative stabilization of the elbow joint. Results The final consultation 4 months postoperatively showed a stable, centered elbow joint and a normal perfusion of the affected arm. The elbow function was good with a range of motion of 0/0/110° of extension/flexion. Conclusion An elbow dislocation is a complex injury. An accurate clinical examination of possible concomitant injuries is important and should be repeated in the first few days after the occurrence. Vascular reconstruction should be performed immediately. In the case of persistent joint instability, an operative stabilization is indicated and may be supported by a hinged external fixator.

Open reduction of an old and unreduced posterior elbow dislocation

The old unreduced elbow dislocation is not very frequent, but when it is found, it is a challenge for every surgeon. We present a case of 65 years old man who came to the hospital with a dislocated elbow. After the first attempt to reduce, the elbow was mobilized in sling for 2 weeks, but during a small effort, the joint dislocated again. Another two orthopedic reduction were tried, followed by cast immobilization, but the elbow dislocated again. The patient presented in our service after two months from the injury with stiff joint in a vicious position. On imagistic examinations (Rx, CT, MRI), it was found comminuted fracture of coronoid process, posterior dislocation of olecranon and both collateral ligaments were torn. An open reduction was performed during which the joint surface was cleaned up, the anterior capsule was reattached to the coronoid process with an anchor, and then, collateral ligament was restored with the help of autograft, a gracilis muscle (bone fixed with two anchors). Postoperatively, the patient slowly began to mobilize the elbow with splint protection. After a year, the patient returned for follow-up; the function was completely restored and he had no pain.

Diaphyseal Radius Fracture Associated with Irreducible Head Dislocation. Case Report

AbstractIrreducible dislocation of the radial head is an extremely rare lesion, especially in an adult patient. We present a case of diaphyseal radius fracture associated with a posterior elbow dislocation and an irreducible radial head dislocation. After closed reduction of the elbow, we performed open reduction and ostheosynthesis of the radius, and the radial head remained irreducible. We finally found, surrounding the radius, the interposition of the insertion of the biceps, and, after extracting it, we performed the correct reduction of the radial head. Six months after the surgery, the patient presented a full articular balance, with no pain. We have not found any similar case in the literature.

Recurrent posterior elbow dislocation caused by congenital abnormalities in a 7-year-old child

BACKGROUND: Congenital posterior elbow dislocation in children is a rare and scarcely reported condition. Owing to the difficulties of an early primary diagnosis and the lack of a standardized management, we present a clinical case of an analysis of surgical treatment according to literature and based on our experience.
 CLINICAL CASE: We present a case of congenital posterior elbow dislocation in a 7-year-old child. In the absence of a universal algorithm for surgical treatment, we performed an arthrotomy for visual assessment of articular surfaces, intervention on the capsule and tendons of m. brachialis, m. biceps brachii, m. brachioradialis, and modeling of the proximal epiphysis of the right radius.
 DISCUSSION: We analyzed surgical treatment options and made an overview of the main stabilizers of the elbow joint that prevent elbow dislocations. There are few publications on this condition; to our knowledge, over the past 10 years, only two clinical cases of a similar pathology in children had been published. Not a single case of congenital elbow dislocation in the neonatal period has been described. We analyzed early clinical manifestations and possible causes of delayed primary diagnosis.
 CONCLUSIONS: Recurrent posterior elbow dislocation of the congenital origin is associated with a functional deficiency of elbow joint stabilizers. In the neonatal period, these abnormalities are usually not detected. The first episode of dislocation may be triggered by a minor trauma without damaging the bone structures. Delayed primary diagnosis may be associated with the paucity of clinical symptoms and compensatory functionality in children. The decision on surgical correction should be based on the analysis of structural anatomical changes in the assessment, of which magnetic resonance imaging plays an important role.

Neglected Elbow Dislocation treated with Hinged External Fixator-A Case Report

Elbow dislocations are treated in emergency. Neglected elbow posterior dislocations are very rarely seen and the treatment for neglected cases is more complicated than acute cases. We present a case of. Neglected posterior dislocation of the elbow treated with open reduction and hinged external fixator. 23-year-old male patient presented with neglected posterior dislocation of left elbow without neurological deficit following fall from height. Patient was initially treated by an osteopath for two months and came to our hospital . Patient underwent open reduction of left elbow and hinged external fixator application under general anaesthesia. Post-operative rehabilitation was started after 6 weeks and after 3 months of surgery patient attained full range of movements in left elbow without any residual instability. The treatment for neglected elbow dislocation is quite challenging. Open reduction and hinged external fixation have satisfactory results with the possibility of early rehabilitation. This method can be considered as an option for such cases. Keywords: Elbow joint, Posterior dislocation, Hinged external fixator

Open Reduction on very late-presenting unreduced posterior elbow dislocation: Still promising treatment option

BackgroundNeglected dislocation of the elbow is associated with instability, pain, and limitation of elbow function. In developing countries, neglected dislocations of the elbow are quite common, and most patients initially go to local bonesetters, which only aggravates the problem. Presentation of caseTwo patients with a history of unreduced posterior elbow dislocation for more than 1 year and were treated by a traditional bonesetter were included in this case study. The first case was a 65-year-old female with a history of injury around her right elbow around 12 months before admission. The patient underwent open reduction with triceps lengthening and immobilization with plaster of paris for 3 weeks. The second case was a 53-year-old male with a history of injury caused by a fall on an outstretched hand around 18 months before admission. The patient underwent arthrolysis followed by triceps lengthening, internal fixation with transarticular k-wire, and immobilization with elbow slab for 3 weeks. DiscussionTo optimize treatment goals and patient function, various surgical approaches have been described for treating chronic elbow dislocations. The benefit of the VY triceps lengthening is to simplify the reduction procedure, especially in the elbow dislocations with greater chronicity. The downside of the VY lengthening is possible triceps weakness, delayed physiotherapy, and increased postsurgical pain. On the basis of this study, open reduction should remain a treatment option for patients regardless of age and chronicity of injury. ConclusionOperative treatment of late-presenting, unreduced elbow dislocation is effective in restoring the joint to a painless, stable, and functional limb.

The fracture of the two bones of the forearm associated with a posterior elbow dislocation: Case report

The fracture of the two bones of the forearm associated with posterior dislocation of the elbow is a very rare lesion and infrequent, either in current practice or in the literature. We report a case in a 37-year-old youth who was the victim of a sports accident with a follow-up of one year. Treatment consisted of closed reduction of the elbow dislocation followed by open osteosynthesis of the fracture of both bones of the forearm. The elbow was stable after reduction and the outcome was favourable despite the complexity of the lesion.

Brachial Vessel Disruption Resulting From Posterior Elbow Dislocation

Brachial Vessel Disruption Resulting From Posterior Elbow Dislocation

Distribution of Osteochondral Lesions in Patients With Simple Elbow Dislocations Based on MRI Analysis.

Background:The clinical relationship between osteochondral lesions and long-term outcomes and patterns in the elbow joint has not yet been established. A sole evaluation from plain standard radiography may underestimate the severity of bony lesions in patients with simple dislocations. It has been suggested that the mechanism of a posterior elbow dislocation could be inferred from the pattern of bony contusions and osteochondral lesions visible on magnetic resonance imaging (MRI) in patients with simple elbow dislocations.Purpose/Hypothesis:The purpose of this study was to describe the incidence and distribution of osteochondral lesions based on MRI findings in patients with simple elbow dislocations. We hypothesized that (1) osteochondral lesions are consistently found in patients with simple elbow dislocations and (2) the distribution and severity of osteochondral lesions may explain the mechanism of the simple elbow dislocation.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review of 43 patients with simple elbow dislocations was performed in tertiary-level hospitals from January 2010 to August 2019. Two orthopaedic surgeons separately assessed the initial plain radiographs and MRI scans. Osteochondral lesions were evaluated and categorized based on whether they were located (1) on the lateral side (posterolateral capitellum and radial head; type 1) or (2) on the medial side (posterior trochlea and anteromedial facet of the coronoid; type 2). The severity of the osteochondral lesions was assessed according to the Anderson classification.Results:Of the 43 patients, 21 (48.8%) presented with osteochondral lesions on MRI. The type 1 pattern of osteochondral lesions was the most frequently observed on MRI in patients with simple elbow dislocations (69.8% of cases), and these were confirmed by simple radiography. Posterolateral capitellum osteochondral lesions were found in 13 patients. Among them, 10 (76.9%) were advanced-stage lesions (stages III and IV according to the Anderson classification).Conclusion:Osteochondral lesions were found on MRI after simple elbow dislocations at a rate of 48.8%. Osteochondral lesions in the posterolateral capitellum were associated with an advanced stage. Clinically, these findings may help surgeons in the diagnosis of osteochondral lesions and in determining how to manage patients with the progression of arthritic changes.

Median Nerve Palsy following Posterior Dislocation of Elbow Joint: A Case Report


 
 
 
 Median nerve entrapment as a consequence of posterior dislocation of elbow is a rare. The diagnosis is usually missed or delayed. We present a case of median nerve entrapment following dislocation of elbow with medial epicondyle fracture in a 12 years old male child. After 10 days of reduction, the child presented with neurological deficit showing median nerve palsy. Nerve conduction study showed total denervation of median nerve. Nerve release was done by breaking the callus around medial epicondyle with neurolysis. Median nerve entrapment after the elbow dislocation is a very rare entity. High index of suspicion and timely intervention is helpful in diagnosing the case and managing with a good functional recovery.
 
 
 

Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome.

The combination of posterior elbow dislocation, radial head fracture, and coronoid fracture has been named "terrible triad" as this injury is difficult to treat and yield poor outcomes. Some studies compared the results of radial head fixation to replacement in isolated radial head fractures, very few reports have tried to compare both treatment modalities in the setting of a terrible triad injury.The aim of this study was to compare the functional outcome of radial head fixation vs replacement in terrible triad injuries of the elbow. A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from April 2016 to April 2019.A total of 30 patients with terrible triad injury of the elbow were enrolled. The primary outcome was the Quick Disability of Arm, Shoulder and Hand (Quick-DASH) at 1year. The secondary outcomes were to report the Mayo Elbow Performance Score (MEPS)at 1 year and elbow range of motion. At final follow up for each patient (13.4 ± 1.2months) The Quick-DASH score at 1year for fixation group was 5 ± 2.3, for the replacement group it was 7.1 ± 7.1. The MEPS at 1year for fixation group was 93.6 ± 8.4, for the replacement group it was 90.9 ± 9.4.Loss of elbow extension at 1year for fixation group was 17.1° ± 10.7°, for replacement group it was 18.75° ± 11.5°. A systematic approach to address the bony and soft tissue components of terrible triad elbow injury is crucial to obtain satisfactory outcome. Our study shows that radial head repair andreplacement, in the setting of terrible triad injury,yields comparable results. Level II, Therapeutic study.

Elbow Dislocation with Ipsilateral Radial Shaft Fracture – A Case Report

Background Posterior dislocation of the elbow associated to a radial shaft fracture is a rare lesion, its treatment is difficult and complicated, and the indications, surgical options, and timing of surgery may vary. In the present case, we performed immediately after the trauma (urgent care) an open reduction internal fixation (ORIF) surgery of the radial fracture by means of a 3.5 mm locking plate, associated to closed elbow reduction and stabilization with dynamic bracing. Case Report A 26-year-old woman was seen in our service with a traumatic deformity of her right, dominant forearm and elbow after a fall from a balance board and presented with a radial shaft fracture and posterior elbow dislocation. The palmar approach was used and the shaft fracture was fixated. During the radial fracture reduction maneuver, the dislocation of the elbow was spontaneously reduced. At 1 year postoperatively, the patient showed good wrist, forearm, and elbow range of motion (ROM). Disabilities of the arm, shoulder and hand (DASH) score of 5, visual analogue scale (VAS) of 0, and grip strength of 92%, as compared with the nonaffected side. Clinical Relevance Nowadays, case reports of concomitant, ipsilateral multiple injuries that uncommonly occur together in a single traumatic episode are very rare. The awareness of this association for early recognition is of paramount significance for ideal clinical results.

Elbow dislocation with ipsilateral fracture of radius and ulna in a child – Case report and literature review

Fracture of diaphyseal forearm bones is common, while the elbow dislocation is a rare injury in the pediatric age group. Both injuries are widely reported in isolation or with various associated injuries. The concomitant association of both of these injuries even in adults is only described in the literature as sporadic case reports. The simultaneous presence of both of these injuries in children is even rarer. Here, we present a case of a 9-year-old child with posterior elbow dislocation and ipsilateral diaphyseal fracture of both bones of forearm that was appropriately managed with good outcome. Only one case has been reported younger than ours as per the literature search by authors regarding similar cases.