Posterolateral Elbow Dislocation Research Articles

An Analysis of Patient-Reported Outcomes Measurement Information System (PROMIS) in Non-operative Posterolateral Elbow Dislocations.

The purpose of our study is to analyze the outcomes of traumatic posterolateral elbow dislocations using patient-reported outcomes measurement information system (PROMIS). We hypothesized that physical function (PF) and upper extremity (UE) scores inPROMIS will significantly improve over six months of follow-up and correlate with a positive change in the patient-acceptable symptom state (PASS). This is a seven-year retrospective study of 165 consecutive adult patients with traumatic posterolateral elbow dislocations. Demographic information, PROMIS PF, PROMIS UE, PROMIS pain interference (PI), PROMIS depression, and PASS were recorded over six months of follow-up. At the time of injury, mean PROMIS scores were PF 41.24 (SD 11.16), UE 34.27 (SD 11.87), PI 60.44 (SD 8.07), and depression 49.82 (SD 10.42). At six months, the mean PROMIS scores were PF 39.71 (SD 9.71), UE 33.95 (SD 9.09), PI 57.35 (SD 8.59), and depression 51.43 (SD 10.62). The overall six-month changes in PROMIS scores were PF -1.53, UE -0.32, PI -3.09, and depression +1.61. At the 6-month follow-up, 41.7% responded positively on the PASS, which correlated only with PROMIS PI. Among patients who improved from negative to positive response on PASS, the PROMIS PF, UE, and depression scores did not significantly improve. Only PROMIS PI correlated with PASS at the six-month follow-up; PROMIS PI significantly improved among simple posterolateral elbow dislocation patients at both short-term and long-term follow-up points. PROMIS PF, UE, and depression did not significantly differ between time of injury and short-term and long-term follow-up points.

Medial Displacement of the Radial Shaft with Fracture of the Radial Neck and Proximal Ulna

Introduction: Fractures of the neck and head of the radius in children are relatively uncommon, constituting 4% to 7% of elbow fractures and dislocations. A child with a fracture of the radial neck and proximal ulna with complete medial displacement of the radial shaft is presented and the classification of the injury is discussed. Objective: To assess the medial displacement of the radial shaft with fracture of the radial neck and proximal ulna. Materials & Methods: This was a retrospective study conducted at Dept. of Ortho-Surgery, Patuakhali Medical College Hospital, Patuakhali, Bangladesh from January 2018 to December 2021. Twelve patients who had displaced radial neck fractures (Judet type III and type IV) treated. Patients were assessed for functional outcome by Mayo elbow performance score (MEPS), the Tibone and Stoltz functional criteria, and for complications with the average follow-up of four years (range: six months to seven years). Inclusion criteria were Judet type III and type IV radial neck fractures, open physis of radial neck at the time of fracture, minimum follow up time of six months. Exclusion criteria were open fractures and Judet type I and type II radial neck fractures. Results: The mean age of the patients was 9.12±2.2 years (range: 4 to 14 years). Nine (75%) patients were males and three (25%) patients were females. The right side was the most commonly injured side (right at 68% and left at 32%). 60% cases were of Judet type III and IV 40% cases were of Judet type IV. The mean fracture angulation of the series was 56.5 degrees (range 33.2 degrees to 79.2 degrees). Five patients had isolated radial neck fractures and five patients had associated proximal ulna fractures and two patients had associated posterolateral elbow dislocation. Six cases required open reduction and K-wire fixation as closed and percutaneous pin leverage techniques did not achieve acceptable reduction. The mean follow-up of all patients was four years ............

Posterolateral elbow dislocation with incarcerated medial epicondyle in a twelve-year old male: A case report and a brief literature review

Posterolateral elbow dislocation with incarcerated medial epicondyle in a twelve-year old male: A case report and a brief literature review

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.

Elbow Fracture Dislocation in Adult: A Case Report

Elbow dislocation may lead to disabling consequences such as elbow instability or stiffness. Complex elbow dislocation is associated with expected fracture patterns such as radial head, coronoid process, and terrible triad. On the other hand, simple dislocation is the dislocation without bony injury and is associated with a favorable prognosis. The following report describes a thirty-eight-year-old male who developed complex posterolateral elbow dislocation with irreducible trochlear fractures that blocked the reduction and mandated open reduction.

Inveterate elbow dislocation: surgical reduction with triceps lengthening

Inveterate elbow dislocations remain common in developing countries. We report the case of a 17-year-old child who consulted us after six months of trauma to the left elbow. Clinical examination revealed a deformed elbow, locked in extension with a mobility sector of 5°. The Mayo Clinic Elbow performance score was sixty-six; the downstream vasculo-nervous examination was normal. The face and profile X-ray of the elbow showed a pure posterolateral elbow dislocation. We used the posterior medial para-tricipital and lateral approach, a first stage of arthrolysis was performed. A complete reduction was achieved by progressive and non-traumatic gentle maneuvers. Intraoperative elbow flexion was less than 80°, indicating a retraction of the triceps muscle, so a Z-lengthening plasty was necessary. This reduction was then fixed with two olecranon-humeral K-wires. At the third week, the plaster cast and K-wires were removed. The patient was subsequently referred to a physical therapist. After a ten-month follow-up, an undistorted and functional elbow with a gain of twenty-one points according to the Mayo Clinic score was obtained. Surgical reduction of a neglected elbow dislocation with triceps lengthening plasty, followed by a codified physical therapy program, results in a remarkable restoration of elbow function and stability. Keyword : elbow, dislocation, inveterate, reduction, triceps.

Unusual Combination of Postero-Lateral Elbow Dislocation and Ipsilateral Diaphyseal Radial Fracture: A Case Report and Review of Literature

The combination of a radial diaphysis fracture and ipsilateral elbow dislocation is a rare lesion. Only a few similar cases have been reported in the literature. Such injuries need a concentric reduction of the dislocation and an anatomical fixation of the radius for optimal functional outcomes. The radial fracture and ipsilateral dislocation of the elbow were probably caused by forearm hypersupination with extension of the elbow. Closed reduction of the elbow and operative stabilization of radial fracture were done with good clinical, radiological and functional outcomes in 8 months follow-up period. We discuss through a clinical case of a radial shaft fracture unusually associated with postero-lateral elbow dislocation and through a review of the literature the clinical aspects, the mechanism, treatment and the evolving profile of this particular lesion.

The \u201cfloating ulna\u201d injury in adults: a case report, literature review and proposed injury classification

BackgroundIpsilateral Galeazzi fracture with elbow dislocation, namely the “floating ulna” injury, is a rare injury pattern. A few reports have described this type of injury and its treatment.Case presentationA 33-year-old female at 38+ weeks gestational age presented with Galeazzi fracture and posterolateral elbow dislocation of the left upper extremity. The patient was treated with closed reduction of the elbow, open reduction, and internal fixation of the radial shaft fracture with a dynamic compression plate and K-wire stabilization of the unstable distal radioulnar joint. At the 12-month follow-up, the patient had no pain or signs of instability. Range of motion was 0–135° at the elbow, 70° extension and 80° flexion at the wrist, and 80° supination and 80° pronation at the forearm.ConclusionThe “floating ulna” injury is a rare and special injury pattern with ipsilateral Galeazzi fracture and elbow dislocation. This type of injury was likely caused by significant amount of deforming force and the unique position of upper limb when the patient fell from a height of 1–2 m in high-energy trauma.

Common Extensor Complex Is a Predictor to Determine the Stability in Simple Posterolateral Elbow Dislocation: Analysis of MR Images of Stable vs. Unstable Dislocation

Simple posterolateral elbow dislocations (SPLED) may be treated nonoperatively using closed reduction, followed by controlled mobilization. However, the extent of soft tissue injuries might affect the choice of treatment, rehabilitation approach, and prognosis. The purpose of this study is to compare the characteristics of soft tissue injuries between patients with unstable and stable SPLED using MRI findings. Thirty MRIs of elbows with SPLED (unstable group (n = 15); stable group (n = 15)) were randomly reviewed by two experienced musculoskeletal radiologists. Soft tissue injuries were characterized as an intact, partial tear or complete tear for the: medial collateral ligament (MCL) complex, common flexor complex, lateral collateral ligament (LCL) complex, common extensor complex, anterior capsule, and posterior capsule. Moderate to substantial interobserver reliability and substantial to perfect intraobserver reliability were observed for medial and lateral complexes in SPLED. The proportion of soft-tissue injuries of the common extensor complex were significantly different between the unstable (four partial tears and 11 complete tears) and stable groups (11 partial tears and four complete tears). In conclusion, based on MRI findings, the degree of common extensor complex injuries may be a predictor of stability and help inform treatment decisions for SPLED.

Thrombosis of the brachial artery - a rare and devastating complication after a simple closed posterolateral elbow dislocation.

Dislocation of the elbow joint is the second most common dislocation after the shoulder joint. Although this pathology is relatively common, concomitant vascular injuries are rare. We present a case of a patient who sustained a fall on his arm with an outstretched elbow that resulted in a closed simple posterolateral elbow dislocation and delayed thrombosis of the brachial artery followed by two revascularisation surgeries. The physician must always maintain a high index of suspicion for a concomitant vascular injury before and after closed reduction of the elbow joint and have in mind that complete ischemia without any pulsations could be absent because the elbow is surrounded by rich collateral anastomoses. Suspicion should be even stronger in the presence of bony lesions or open injuries. A team of trauma and vascular surgeons has to work hand in hand as surgical treatment with a saphenous graft or direct suture is the first method of choice with the prior requirement of a stable elbow joint.

Treatment of posteromedial and posterolateral dislocation of the acute unstable elbow joint: a strategic approach

The purpose of this study was to evaluate the different treatment strategies for posterolateral and posteromedial elbow dislocation. The study enrolled 21 patients with unstable simple elbow dislocation including 16 cases of posterolateral dislocation (PLDL) and 5 cases of posteromedial dislocation (PMDL). In patients with PLDL, the medial side was evaluated and repaired first, followed by the lateral side. In patients with PMDL, the lateral side was repaired first, followed by the medial side according to residual instability. Among the 16 cases of unstable PLDL, 7 of 9 presenting with complex combined tear of the ulnar collateral ligament (UCL) and flexor muscle on magnetic resonance imaging showed abnormality on valgus stress testing and UCL repair. Three of 7 cases required additional lateral collateral ligament complex (LCLC) repair. Two of 9 cases showing medial complex dual lesions had normal findings on valgus stress testing and were treated only with LCLC repair. Seven of 16 cases without medial complex dual lesion had normal findings on valgus stress testing, and only LCLC repair was performed. All 5 cases of unstable PMDL showed distraction-type LCLC injury on magnetic resonance imaging and required no additional UCL repair after LCLC repair. There were no cases of recurrent instability following this treatment algorithm. In unstable elbow dislocation, PLDL and PMDL are caused by different mechanisms following damage to different structures. Therefore, different strategies are needed to ameliorate the dislocation and instability.

What’s New in Orthopaedic Trauma

What’s New in Orthopaedic Trauma

Ligaments injuries check-up and assessment of their healing potential in simple posterolateral elbow dislocation: about 25 cases.

Elbow dislocation can lead to instability and stiffness of the elbow. The main goal of this study was to list the initial elbow ligaments injuries caused by simple posterolateral elbow dislocations. The secondary goals were to assess ligament healing 2months after the initial dislocation, to research a correlation between ligaments injuries and clinical course, and to search for predictive factors of instability. Patients who had simple posterolateral elbow dislocation for the first time between January 2015 and May 2016 were included. Each patient had an MRI scan of their traumatised elbow on the day of the dislocation and then again 2months later. The assessment was performed thanks to a clinical examination and calculation of functional recovery scores. The Mann-Whitney U test was used to research a correlation between the healing of ligaments injuries and clinical course. Twenty-five patients were included in the study. The initial MRI scans showed 70% and 54% ligament rupture, respectively, for the anterior band (ant MCL) and the posterior band (post MCL) of the medial collateral ligament (MCL), as well as 79% for the ulnar (ULCL) and 50% for the radial (RLCL) lateral collateral ligaments. The healing rate 2months after dislocation was fairly low from 18% for the ULCL up to 41% for the anterior band of the MCL. No correlation was found between the ligament healing noticeable on MRI scans and clinical course. No elbow instability was diagnosed during the 4-month follow-up. Elbow dislocation is particularly damaging for ligaments. There is no predominance on medial or lateral ligament for rupture. The low healing rate 2months after the initial dislocation could be explained by performing a follow-up MRI scan too early.

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.

Current treatment concepts for "terrible triad" injuries of the elbow.

Elbow fracture-dislocations destabilize the elbow, preventing functional rehabilitation. If left untreated, they commonly result in functional compromise and poor outcomes. The "terrible triad" injury is classically described as a combination of a coronoid process and radial head fractures, as well as a posterolateral elbow dislocation. Surgical treatment to restore stable elbow range of motion has evolved in the past few decades based on increased understanding of elbow biomechanics and the anatomy of these injuries. This article highlights current concepts in the treatment of these complicated injuries.

A Terrible Quartet Injury of the Elbow: A Terrible Triad Variant with a Capitellar Shear Fracture: A Case Report.

Courtney, P. Maxwell MD1; Shah, Roshan P. MD, JD1; Mehta, Samir MD1; Donegan, Derek J. MD1 Author Information

OUR EXPERINCE OF A CASE OF TERRIBLE TRIAD OF ELBOW

AbstractDislocation of the elbow joint in association with fracture of radial head and fracture of coronoid process, is referred to as “terrible triad” of the elbow, the treatment of which provides a challenge to treating surgeon due to its complicated outcomes. The understanding of the elbow kinematics, the usage of various implants and surgical techniques in the recent years has led to the development of standard treatment protocols. The 'terrible triad' of the elbow is a severe injury that is difficult to treat and has a poor prognosis in the medium-tolong term. It is characterised most often by instability of the elbow, development of arthrosis and joint stiffness.A 43 year old lady presented to us after a fall on outstretched dominant hand with severe pain and swelling around elbow. She had sustained a fracture of the radial neck and coronoid process with posterolateral dislocation of elbow. Immediate Closed reduction of the dislocation was performed under GA and elbow was immobilised in a plaster of paris slab for 3 weeks. She underwent operative procedure of open reduction and internal fixation of the radial head with a titanium plate and the coronoid process with a 4mm screw and washer after 10 days.After 3 weeks elbow rehabilitation was begun and at one year post surgery there was signs of fracture healing with full range of motion of the elbow.

Occult posterolateral rotatory dislocation of the elbow with olecranon fracture in a child: a case report

IntroductionAcute posterolateral rotator elbow dislocation in a child is rare and can be easily misdiagnosed due to immaturity of the epiphysis. This is the first case of occult posterolateral rotator elbow dislocation in combination with an olecranon fracture. We report our experience with this case, which was not diagnosed correctly by plain radiographs.Case presentationAn 11-year-old Asian boy suffered severe pain and swelling of his right elbow after his outstretched arm hit a car dashboard in a motor vehicle accident. Plain radiographs showed only a minimally displaced olecranon fracture and a tiny lateral epicondylar avulsion fracture. However, stress radiographs under general anesthesia revealed severe posterolateral rotatory instability. During surgery, we found that the cartilaginous lateral epicondylar apophysis was much larger than the epicondylar fragment on the radiographs. After the lateral epicondylar osteochondral fragment and lateral collateral ligament complex were fixed, the instability disappeared.ConclusionOur experience with this case shows that it is important to check for instability with pediatric elbow fractures, because a tiny avulsion fracture was able to cause severe posterolateral rotatory instability in a child.

Triple injury of forearm and elbow—a case report

Fracture of the forearm with ipsilateral dislocation of the elbow is uncommon. Such double injuries are often missed at initial assessment. We report a case of triple injury of forearm and elbow—open elbow dislocation, closed distal radius, and ulna fracture with missed medial epicondyle fracture. To the best of our knowledge, this has not been previously described in literature. The most probable mechanism of injury is a fall on outstretched hand with wrist in dorsiflexion causing the distal radius and ulna fracture with dorsal displacement. Further continuation of the axial compression along with supination of the forearm and valgus at the elbow resulted in posterolateral elbow dislocation and a medial epicondyle avulsion. Early debridement and reduction resulted in satisfactory function. The report attempts to highlight the importance of good clinical and radiological assessment and to understand the mechanism of injury, to rule out other injuries caused by the same mechanism.

IPSILATERAL SIMULTANEOUS SHOULDER AND ELBOW DISLOCATION a case report

Ipsilateral dislocation of the shoulder and elbow joints is a rare and complex injury. Only six patients have been reported in the international literature with ipsilateral dislocation of the shoulder and elbow. Here, we reported a 48 year-old woman who suffered ipsilateral shoulder and elbow dislocation. The patient first presented to a regional hospital and the radiographs taken following the initial evaluation revealed posterolateral dislocation of right elbow. The reduction of the dislocated elbow was performed at that facility. However, since no radiographic examination of the injured shoulder had been carried out, the dislocation injury of the shoulder was missed. Three days later the patient presented to Tepecik Training and Research Hospital emergency Department (Izmir-Turkey), complaining of shoulder pain. Radiographs showed the missed anterior dislocation of right shoulder, which had been reduced under general anaesthesia. At final follow-up, 2.5 years later, the elbow and the shoulder were pain free and had full range of motion. Following a high energy trauma in upper extremities, radiographic examination of the shoulder, elbow and wrists must be performed in case of suspicion.