Posteromedial Elbow Dislocation – Case Report

EEXOT
Volume 63, (2): 75-78, 2012

STAVRAKIS A.T, ADAMOPOULOS P, PAPADOPOULOS P, MOURGIAS N, MPAKIRTZIS D, KAPETANAKIS S
Orthopaedic Department – Amalia Fleming General Hospital, Melissia, Athens

ABSTRACT

We describe the case of a male patient, 55 years old, with an posteromedial elbow dislocation and with skin lesion, after fall to the ground without fracture. The patient was treated with close reduction under general anesthesia. Then we examinate the elbow stability and the range of motion with excellent results. We evaluate the elbow using C.T. and M.R.I. After reduction we proceed with plaster immobilization in 90 degrees flexion and early motion within the limits of pain. Function, pain and radiographic recovery were evaluated at regular intervals and we conclude the follow-up of the patient 1 year after injury. The primary outcome measure is the Mayo Elbow Performance Index with excellent results. We describe the case and a short review of the literature.

Key words: Posteromedial elbow dislocation, Mayo Elbow Performance Index.

INTRODUCTION The dislocation of the elbow is the second most common major joint dislocation after shoulder dislocation in adults. The injuries are classified according to the position displacement of the cluster radius-ulna. These are purely back out and back which is the most common, followed in frequency through the rear, the front partition and dislocations. Also classified into simple (no fracture and composite (fracture). In 90% of dislocations of the elbow complex kerkidoleniko parektopizetai

Mailing Address: Orthopaedic Department – Amalia Fleming General Hospital  Melissia, Athens
back and out. Approximately 20% of dislocations coexist bone fractures of the participants.The principles of treatment of simple dislocations include closed reduction and rapid mobilization, except in those rare cases where closed reduction is impossible because of interference soft tissue or osteochondral pieces among the displaced articular surfaces. For the period of immobilization after reduction, the literature we find different opinions. We decided to present this case for two reasons: This rear-through elbow dislocation is rare that occurs after a 9% rate on all types of dislocation of this joint. The dislocation-accompanied with trauma to the inside front surface of the inner elbow and not accompanied by fracture, which is also rare.

CASE REPORT

This is a man aged 55, full-bodied and overweight, a special guard, who says falling on slippery ground smooth and the right upper limb is fully extended and pronated. Joined outpatient immediately after the accident and the other strain in the joint, local swelling, intense pain and loss of motion found in trauma 2cm medial fossa of the elbow that was considered to have occurred from within. The neuromuscular status of the limb was no such deficits and adjacent joints, shoulder and Wrist. The radiological evaluation showed posterior elbow dislocation through without apparent bone involvement (Figure 1.2). The reduction was achieved after general anesthesia and was closed. The technique was attracted by the long axis of the humerus in order to unlock the koronoeidis olekraniko

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outgrowth from the tank and while the arm is held by a third pulled anteriorly forearm with the elbow slightly flexed. Under anesthesia and after cardioversion were tests for detection of instability. Ie varus – valgus alignment at full extension and flexion 20th which showed a slight deficiency of the lateral collateral ligament and the joint did not seem to break up and then until the 60th and full flexion. VPK posterior splint came 90th in decline. The response to the trauma outpatient would like to fracture complicated, and in part remained under observation and antibiotics for four days.
Followed by CT (Figure 3.4) for control of joint and bone data to verify the existence of fracture and were
without pathological findings and the MRI (Figure 5) showed: a) Complete breaking out collateral ligament b) rupture during myotenontia contribution insertion of the extensor muscles c) contusion with rupture of the larger portion of the flexor tendon ekfytikou when myotenontia outgrowth outgrowth of parakondylio d) The inner lateral link is represented by good anatomical continuity.
The review found after seven days cruising speeds wound healing, swelling on the joint to decline gradually while the blood count and inflammatory markers were found within normal limits (Figure 6). The joint range of motion ranged from the 20th until the 90th decline. He established daily remove the splint and perform exercises bending area

 

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Αδαμόπουλος Παναγιώτης Χειρουργός Ορθοπαιδικός Μαρούσι
Figure 5. MRI.

within the limits of pain in order to gradually improve. By the end of the third week apekatestathi full range of motion in both flexion area in pronation and supination and the reported symptoms were minimal.

The review of the patient after one year, the results remained excellent, as is shown by the rating scale based on the MEPS (Mayo Elbow Performance Score). The radiological evaluation showed mild ectopic ossification in the region of the medial collateral ligament (Figure 7-8).

DISCUSSION

Through the posterior dislocation of the elbow seemed to respond well to regular routine treatment, ie technical reduction, immobilization, mobilization, such that the

most common posterior and posterior dislocations out. The wound from the inside despite initial certainty that was caused by bone fracture strain of the joint healed by second order soon. And here was this complete rupture of the lateral collateral ligament with intact while the medial impression caused by the concomitant lesions of the extensor and kamtiron at the origin of these. These lesions showed no influence on muscle strength.

REFERENCE

1. Apley’s System of Orthopaedics and Fractures. 8th Edition. Louis Solomon, David Warwick, Selvadurai Nayagam. London 2007 by Arnold (A member of the Hobber Group).
2. Campbell’s Operative Orthopaedics. 11th Edition. S. Terry

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Canale, James H. Beaty. Philadelphia – USA 2008 by MOSBY editions.
3. Mark D. Miller. Review of Orthopaedics, 5th Edition .Philadelphia – USA 2008 by Saunders Elsevier.
4. Borris et al., 1987. Borris LC, Lassen MR, Christensen CS: Elbow dislocation in children and adults: a long-term follow-up of conservatively treated patients. Acta Orthop Scand 1987; 58:649.
5. Josefsson et al., 1987. Josefsson PO, Gentz C-F, Johnell O, et al: Surgical versus nonsurgical treatment of ligamentous injuries following dislocation of the elbow joint: a prospective randomized study. J Bone Joint Surg 1987; 69A:605.
6. Mehlhoff et al., 1988. Mehlhoff TL, Noble PC, Bennett JB, et al: Simple dislocation of the elbow in the adult: results after closed treatment. J Bone Joint Surg 1988; 70A:244.
7. Current Concepts: Simple and Complex Elbow Dislocations – Acute and Definitive Treatment. Pascal Jungbluth et al. Department of Trauma and Hand Surgery, Heinrich Heine University Hospital Duesseldorf, Germany Eur J Trauma Emerg Surg 2008; 34:120-30.
8. Functional treatment versus plaster for simple elbow dislocations (FuncSiE): a randomized trial. Jeroen de Haan, Dennis den Hartog et al. BMC Musculoskeletal Disorders 2010; 11:263.
9. Dislocation of the Elbow: a retrospective multicentre study of 86 patients. Jeroen de Haan et al. Open Orthop J. 2010; 4:76- 79.
10. Post-traumatic Posterior Radial Head Subluxation. Two Case Reports. Ronald C et al. Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan. Clinical Orthopaedics and Related Research June 24, 1982, p.192-194.

EEXOT
Volume 63, (2): 75-78, 2012

STAVRAKIS A.T, ADAMOPOULOS P, PAPADOPOULOS P, MOURGIAS N, MPAKIRTZIS D, KAPETANAKIS S
Orthopaedic Department – Amalia Fleming General Hospital, Melissia, Athens

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Ο Συντάκτης: Παναγιώτης Αδαμόπουλος

Ορθοπαιδικός Χειρουργός, Διδάκτορας Πανεπιστημίου Αθηνών. Eπιμελητής Γ.Ν. Κορίνθου

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