Epidemiology and treatment of acute elbow dislocations: current concept based on primary surgical ligament repair of unstable simple elbow dislocations

Chronic Complex elbow fracture dislocation: Restoration of elbow function with ORIF and radial head replacement, a case report with long term follow up

INTRODUCTION

The dislocation of the elbow joint to the posterior or postero-lateral region accompanied by fractures in the radial head or neck and coronoid process of the Ulna is known as a terrible triad injury of the elbow (TTI).

IMPORTANCE

This injury presents as unique challenge for orthopedic surgeons due to elbow instability and stiffness, making the surgical intervention more difficult than usual.

CASE PRESENTATION

A 47-year-old man suffered from polytrauma, including a pelvis fracture, a left humerus shaft fracture, and left ulna shaft fracture. An open reduction and internal fixation were administered as a treatment option. However, during a follow-up examination four months later, a missed fracture dislocation of the right elbow was discovered.

CLINICAL DISCUSSION

The complex surgery required open reduction of the chronic dislocated joint, release of the triceps, resection of the radial head, replacement, bone grafting of the coronoid, reconstruction of the coronoid, and application of a spanning external fixation. The injury was complex, consisting of coronoid fractures, olecranon, a proximal third of the Ulna, and radial head malunion with heterotrophic ossification around the elbow joint.

CONCLUSION

After seven years, our patient had a full range of motion in elbow flexion with 20-25 lags in extension. The Mayo Elbow Performance Score (MEPS) was 100 and Disabilities of Arm, Shoulder and Hand (DASH) score was 0.

[Elbow joint dislocation : Frequent concomitant injuries and current treatment concepts]

Dislocations of the elbow joint are among the most prevalent dislocation injuries in the human body after shoulder joint dislocations and represent a challenge in the clinical routine because of the concomitant injuries and complications. They predominantly affect young adults who become injured during athletic or daily activities. A distinction is generally made between a simple elbow dislocation and a dislocation fracture of the elbow; however, a uniform classification or treatment algorithm has not yet been established, especially for simple elbow dislocations with associated ligamentous, muscular and capsular concomitant injuries. Due to this and the complexity of this injury, a standardized approach is needed to initiate the optimal treatment at an early stage and to correctly select the narrow treatment pathway between impending chronic instability and elbow stiffness.

A Retrospective Study on Traumatic Elbow Dislocation in Adults in a Tertiary Hospital in Riyadh, Saudi Arabia

Background This retrospective chart review aimed to ascertain the frequency and characteristics of radial head fractures in adults who presented to our emergency department with elbow dislocation. Methodology This study was conducted in a single tertiary trauma center in Riyadh, Saudi Arabia, between July 2015 and July 2020 to identify traumatic elbow dislocation in adults. Patients were identified after thoroughly examining the hospital's electronic X-ray database. In addition, computed tomography (CT) was used to assess complete ulnohumeral joint dislocation. In total, 80 patients between the ages of 18 and 65 were evaluated for a radial head fracture. Various variables were examined. Results Of the 80 patients included, the mean age with standard deviation was 36.9 ± 8.8 years, and all patients were males. Nearly all patients with elbow dislocation had some form of posterior dislocation, including posterolateral (81.3%), posterior (10%), and posteromedial (7.5%) dislocation. The radial head fracture was identified in 48 (60%) cases. Radiographs were sufficient to diagnose 91.3% of radial head fractures, while the remaining 8.8% required additional CT. Conclusions Based on X-ray or CT findings, radial head fractures were found in more than half of traumatic elbow dislocations. In addition, most cases were diagnosed as an elbow dislocation and radial head fracture using only plain radiography, while some required additional CT. Based on these findings, we recommend routine CT to detect suspected elbow dislocation and avoid missing subtle injuries.

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.