Posterior Dislocation Of Elbow Research Articles

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.

New Injury Mechanism and Treatment Algorithm of Posterior Elbow Dislocation

New Injury Mechanism and Treatment Algorithm of Posterior Elbow Dislocation

Posteromedial Elbow Dislocations without Relevant Osseous Lesions: Clinical Characteristics, Soft-Tissue Injury Patterns, Treatments, and Outcomes.

Although simple posterolateral or posterior elbow dislocations are relatively common and usually stable after closed reduction, simple posteromedial dislocations are extremely rare and poorly characterized. We investigated the clinical characteristics, soft-tissue injury patterns, treatments, and outcomes of a series of posteromedial elbow dislocations without relevant osseous lesions. We retrospectively reviewed 20 cases of simple posteromedial elbow dislocations without relevant osseous lesions that were treated at 7 fellowship training hospitals during a 10-year period. Soft-tissue injury patterns in 15 cases were investigated with use of magnetic resonance imaging. Clinical outcomes were evaluated after an average of 56.1 months (range, 24 to 93 months) with use of the Mayo Elbow Performance Score (MEPS) and the Quick-DASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH]) score. Complications were also evaluated. On magnetic resonance imaging, significant tears of the lateral collateral ligament complex and common extensor group were observed in all cases. Seventeen cases (85%) required surgical treatment for acute instability. Fourteen cases underwent only lateral complex repair and 3 underwent repair of both the medial and lateral complexes. At the time of the latest follow-up, the mean MEPS and Quick-DASH scores were 85.8 ± 15.0 and 10.5 ± 16.3, respectively. Seventeen patients (85%) had a satisfactory clinical outcome. Complications following treatment included 4 patients with heterotopic ossification; 2 of these patients also experienced posttraumatic elbow stiffness, which was treated with arthrolysis at 8 and 18 months after the initial operation. Posteromedial elbow dislocations without relevant osseous lesions are associated with a more severe soft-tissue injury, especially to the lateral complex, resulting in a high rate of surgical treatment. With careful post-reduction evaluation, either operative or nonoperative treatment provided satisfactory clinical outcomes. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Complex Posterior Elbow Dislocation Causing Complete Brachial Artery Transection. A Rare Complication of a Common Orthopedic Injury

Complex Posterior Elbow Dislocation Causing Complete Brachial Artery Transection. A Rare Complication of a Common Orthopedic Injury

Clinical and Functional Outcomes of Isolated Posterior Elbow Dislocations in Children: A Case Series

Clinical and Functional Outcomes of Isolated Posterior Elbow Dislocations in Children: A Case Series

Rehabilitation of elbow fractures and dislocations

Elbow fractures and dislocations cause injury to important stabilizing structures and require specific treatment in order to regain functionality of the elbow joint. Regardless of whether surgical or non-surgical treatment is performed, correct rehabilitation following diagnosis of the injury pattern is crucial to achieve the best possible outcome in each individual case. After osteosynthesis, as well as after total elbow arthroplasty of distal humerus fractures, the postoperative protocol depends on whether a triceps-on or triceps-off approach was used. While triceps-on approaches allow active extension immediately postoperatively, triceps-off approaches require a more restrictive protocol. Radial head fractures are frequently accompanied by additional osteoligamentous injuries. Rehabilitation following radial head fractures usually involves active-assisted mobilization over the full range of motion; however, concomitant injuries need to be considered when formulating a treatment plan. Rehabilitation of surgically treated olecranon fractures commonly includes active flexion and gravity-assisted extension. Coronoid fractures are often the result of posterior elbow dislocation, which needs to be kept in mind during rehabilitation of these injuries. Complex proximal ulna fractures (e. g. Monteggia-like injuries) are frequently associated with persisting disability. Simple elbow dislocations are usually treated non-surgically. Early functional treatment should be preferred over prolonged immobilization as it decreases the risk of post-traumatic elbow stiffness without increasing the possibility of persistent instability.

The posterior bundle of the elbow medial collateral ligament: biomechanical study and proposal for a new reconstruction surgical technique.

The medial collateral ligament (MCL) is one of the primary elbows stabilizers. It is composed of an anterior bundle (AB), a posterior bundle (PB) and a transverse bundle. In elbow dislocations, until today MCL reconstruction has addressed the AB only. The purpose of this paper is to understand the biomechanical role of the PB of the MCL and to propose a new surgical technique for the simultaneous reconstruction of the anterior and posterior bundles, preventing the risk of recurrent posterior dislocation or posteromedial rotational instability (PMRI). Sixteen cadaveric elbows were subjected to a force in compression, supination valgus and pronation varus. The residual stability was evaluated in three conditions: intact MCL, sectioned AB and sectioned AB+PB. The tests were performed in collaboration with the Department of Mechanical and Aerospace Engineering of the Politecnico di Torino. In six elbows, the MCL was then reconstructed with the new technique. Complete posterior elbow dislocation does not occur until the PB is sectioned. The section of the AB alone causes elbow instability in valgus stress, but not a dislocation. The reconstruction of the AB and the PB using the described technique allows a good recovery of range of motion and joint stability. The PB of the MCL has a primary role in elbow stability against valgus stress, and it prevents elbow posterior dislocation at all flexion angles. The described reconstruction technique should reduce the risk of residual PMRI.

Neglected old posterior dislocation of elbow: Treatment and results of open reduction

Neglected old dislocations of elbow are found only in developing countries in significant numbers and there is very less literature of this condition from developed countries. It is a huge challenge for orthopaedic surgeons in developing countries as even after treatment it is difficult to achieve full range of motion and function in a neglected case. In this article we report treatment and results of one of the largest series of 15 cases on neglected posterior elbow dislocation. Our management protocol was opening joint through posterior approach and using Speed Technique doing a V-Y plasty for tricep and most of times fixing reduced joint by 2 diverging k wires. At one year follow up

Case Report: Ultrasound-Guided Infraclavicular Brachial Plexus Block for a Case with Posterior Elbow Dislocation

BackgroundThe interest in regional anesthesia procedures for the management of upper-extremity emergencies has increased. Toward that end, supraclavicular, interscalene, or infraclavicular approaches, with or without ultrasound guidance, are used for brachial plexus nerve blocks. Although many studies have reported on the use of ultrasound-guided supraclavicular and interscalene brachial plexus blocks for upper-extremity dislocations, very few studies have reported on the use of ultrasound-guided infraclavicular brachial plexus blocks. Case ReportWe present an adult patient with posterior elbow dislocation that is treated with reduction after applying an ultrasound-guided infraclavicular brachial plexus block. Additionally, we describe the infraclavicular block in detail and demonstrate the technique using images. Why Should an Emergency Physician Be Aware of This?Based on our experience, the ultrasound-guided infraclavicular block is a fast, safe, and efficient anesthesia technique that can be an excellent alternative to sedoanalgesia and other brachial plexus blocks for the management of elbow dislocations in the emergency department.

Neglected Posterior Dislocation of Elbow in Childrens

Neglected Posterior Dislocation of Elbow in Childrens

Fractura-luxación del complejo distal del codo, ¿es la tétrada terrible una nueva entidad?

ObjectiveTo describe the terrible tetrad and treatment algorithm in patients and cadaver models to differentiate it from other entities that affect the distal elbow complex and the differences in their treatment. Material and methodologyWe studied 7 patients (5 women and 2 men) with a mean age of 51 years, who had had posterior or posterolateral elbow dislocation associated with fracture of coronoid process, radial head and olecranon. We reproduced the lesional association tetrad in 3 cadaveric specimens. Treatment included the reduction and stabilization of the coronoid process. We appreciate the clinical results with Broberg and Morrey scales and DASH. ResultsOf the 7 patients who underwent surgery, 4 had to be re-operated. The average functional outcome with Broberg and Morrey scale was fair, 77 (96-38) points, and the DASH was 30 (78-10). The range of flexion and extension was 96° (range 120-45°) and pronosupination of 126° (range 150-40°), mean supination of 57° (range 70-40°) and pronation 48.5° (range 60-30°). ConclusionIn the terrible elbow tetrad the main challenge is the correct preoperative diagnosis and good results are obtained with a stable elbow through proper surgical planning, individualizing rebuilding and repairing articular surfaces and ligamentous structures in a single approach.

Report of a pregnant lady with bilateral elbow dislocation caused by acute fall injury

Simultaneous bilateral posterior elbow dislocations occur rarely with only 14 cases being reported in the literature so far. Of these cases, none occurred in a patient who was pregnant. No cases of bilateral elbow dislocation with a distal radial fracture-dislocation have also been described. A case of a pregnant patient presenting with bilateral elbow dislocation, right wrist fracture-dislocation is reported here and the issues involved in managing such a case are discussed.

Elbow dislocation in a 3 year old child: a report of a rare injury

Elbow joint dislocations are rare injuries in paediatric age group. This pattern of injury has been rarely reported in children under three years of age. Successful conservative management involves urgent reduction with confirmation by imaging in most cases. The presented case is a rare case of posterior elbow dislocation in a 3 year old child successfully managed.

Traumatic Isolated Posterior Elbow Dislocation: Pediatric case report

Traumatic isolated elbow dislocations is rare in early childhood. However, posterior dislocation of the elbow is more common in childhood and is often seen with elbow fractures. In this study, we evaluated a rarely encountered isolated posterior elbow dislocation case developed in a 8-year old boy due to falling on elbow at house. Under general anesthesia, closed reduction and long arm splint was performed and recommended for a two-week immobilisation was recommended for patient. Patients underwent clinical follow-up, it was observed that the elbow can be full and painless.Comparative X-ray of the elbow is diagnostically important.

Humeral Shaft Fracture with Ipsilateral Anterior Shoulder Dislocation and Posterior Elbow Dislocation: A Case Report and Review of the Literature.

Fractures of the humeral shaft are rarely complicated by ipsilateral shoulder or elbow dislocation. While the majority of isolated humeral shaft fractures can be treated nonoperatively, polytrauma, neuromuscular disease, and pathologic fractures are often indications for operative intervention1,2. Injuries resulting in concomitant joint dislocation may be associated with functionally adverse outcomes3. Since first reported in the literature in 1940, there have been twenty-three reports in eighteen papers of humeral shaft fractures associated with anterior shoulder dislocation4. There have been even fewer reports of humeral shaft fractures with ipsilateral posterior shoulder dislocation5,6 or ipsilateral elbow dislocation7. We present a case of an extremely rare injury involving a humeral shaft fracture with ipsilateral shoulder and elbow dislocation. To our knowledge, the simultaneous dislocation of both joints in association with an ipsilateral humeral shaft fracture has been reported only once in the literature7. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-six-year-old black man arrived at our level-I trauma center. He had been struck by a forklift while trying to save a two-year-old child from being hit by the machine. He sustained a left frontal intraparenchymal subarachnoid hemorrhage with associated facial and orbital fractures. Radiographs obtained in the trauma bay and physical examination revealed a fracture of the midshaft of the right humerus with an ipsilateral anterior glenohumeral dislocation and a posterior elbow dislocation (Figs. 1-A and 1-B). Anteroposterior (AP) ( Fig. 1-A ) and lateral ( Fig. 1-B ) radiographs of the right humerus and elbow demonstrating a comminuted oblique midshaft fracture with lateral apex angulation and posterior displacement of the distal fragment. Also evident are the anterior glenohumeral dislocation ( Fig. 1-A ) and the posterior elbow dislocation ( Fig. 1-B ). Fig. 1-A Fig. 1-B While the patient was in the trauma bay, we first turned our attention to the closed joint reductions. We employed general anesthesia to relax the patient adequately. In order to take tension off of the median, ulnar, and radial nerves distally, and to give us a stable and …

The capsular attachment of the ulnar coronoid process

Background: Ulnar coronoid fractures are relatively rare injuries usually occurring in association with elbow dislocations and contributing to elbow instability. Recent evidence supports a role for coronoid tip fractures in elbow instability. The purpose of this study was to determine where the capsule inserts onto the ulnar coronoid process. Methods: Twenty MRI arthrograms from patients with no evidence of osteoarthrosis or posttraumatic changes were evaluated. The distance from the tip of the coronoid process to the proximal edge of the anterior elbow joint was recorded as was the coronoid height. Results: The average distance from the tip of the coronoid process to the proximal edge of the anterior elbow joint capsular insertion was 1.7±1.1 mm. The average coronoid height measured 17.6±1.9 mm. Conclusions: Elbow instability after posterior elbow dislocations is a difficult and well-described entity. There is recent evidence regarding the role of small coronoid fractures in posttraumatic instability. These data support the assertion that most coronoid tip fractures involve disruption of the anterior capsule, which potentially explains why instability can be associated with these fractures.

Ipsilateral fracture dislocation of the shoulder and elbow: A case report and literature review.

Ipsilateral dislocation of the shoulder and elbow is an uncommon injury. A literature review identified nine previously described cases. We are reporting a unique case of ipsilateral posterior shoulder dislocation and anterior elbow dislocation along with concomitant intra-articular fractures of both joints. This is the first report describing this combination of injuries. Successful treatment generally occurs with closed reduction of ipsilateral shoulder and elbow dislocations, usually reducing the elbow first. When combined with a fracture at one or both locations, closed reduction of the dislocations in conjunction with appropriate fracture management can result in a positive functional outcome.

Iatrogenic radial neck fracture on closed reduction of elbow dislocation

Traumatic dislocation of the elbow is rare in children and can most often be managed in the emergency department using procedural sedation and closed reduction with good functional outcome. Radiographs must be evaluated for associated avulsions and fractures around the elbow. We present the case of a 14-year-old girl who sustained a fracture of the radial neck subsequent to repeated attempts at closed reduction of a pure posterior elbow dislocation that was missed on postreduction radiographs. Careful use of reduction techniques and avoidance of repeated forceful manipulations is emphasized.

English

INTRODUCTION: Elbow dislocations are frequently encountered during clinical practice, posterior dislocation being most common while pure lateral being less. Lateral type indicates high energy trauma and significant ligament injury. CASE REPORT: We present here a case of a 55 year old male with a pure lateral dislocation who presented six hours after injury. Closed reduction, attempted under anesthesia, was unsuccessful and had to be open reduced. A tight band of brachialis muscle was noted as cause for failure of closed reduction. DISCUSSION: Pure lateral dislocation being very rare (incidence 0.7%) is associated with significant ligament injuries around the elbow. CONCLUSION: Lateral dislocation of elbow requires careful investigation, early reduction and assessment for elbow instability. INTRODUCTION: Posterior elbow dislocations are most common type of elbow dislocation seen in clinical practice (2).Other types of elbow dislocation such as anterior, medial, lateral and divergent are very rare. We are presenting a rare case of traumatic pure lateral dislocation of elbow in a 55 yr adult male. CASE REPORT: A 55 years-old male, farmer, fell off a bullock-cart, with trauma to partially flexed left elbow. After the trauma, patient noticed severe pain and deformity of his left elbow, for which patient came to the hospital about 6 hours after the injury. On examination, there was swelling around the elbow and lower arm. The medial epicondyle and trochlear groove were prominent and easily palpable. There was widening of the elbow along with lateral displacement of olecranon and radial head. The elbow was in 20-30 degree flexion and the forearm was in supination. There was no neurovascular deficit distally. On X-ray of the left elbow Antero posterior view (figure 1) the olecranon and radial head were lateral to the capitulum while on lateral view the radial head and coronoid process were anterior to capitulum. There was no evidence of any fracture. After 9 hours of injury under general anesthesia closed reduction was tried by traction and varus force on elbow to reduce the prominent medial part of humerus, but it was not reducible. Hence, anteromedial incision over the bony prominence was taken. The distal end of humerus was in subcutaneous plane. The ulnar nerve was identified, medial collateral ligament was found to be detached from the humeral side and flexor pronator origin were found torn (figure 2). Through the torn medial capsule, the anterior tight band of brachialis muscle was lifted anteriorly and the elbow

Results of posterior dislocation of elbow associated with bony and soft tissue injury.

Elbow trauma is challenging to manage by virtue of its complex articular structure and capsuloligamentous and musculotendinous arrangements. We included 17 patients with elbow dislocation and associated injuries in this study. The study protocol included early elbow reduction and planned fixation of the medial or lateral condyle, coronoid and radial head. The sample was 73% male and 27% female with mean duration follow-up of 8 months, and mean age of 37 years. The mean Mayo Elbow Performance Score was 96 points at conclusion of follow-up, indicating an excellent result in 14 patients. Whenever the radial head was excised, we performed a strong transosseous ligamentous repair of the medial and lateral collateral ligaments. Fixation of the coronoid is essential for elbow stability. A small avulsed fragment can be fixed using an ACL jig. We found this technique very useful. Early planned intervention, stable fixation, and repair provide sufficient stability and enhance functional outcomes. elbow dislocation, ligament instability, coronoid fracture.