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OJHAS Vol. 10, Issue 1:
(Jan-Mar 2011) |
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| Posterolateral Elbow Dislocation with Ipsilateral Fractures of Head and Distal End Radius |
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Vijay C, Assistant Professor,
Mahendra
Kumar KL, Assistant Professor,
Manjappa
CN, Associate
Professor,
Deepak
CD, Assistant
Professor,
Department of Orthopedics, Adichunchangiri
Institute of Medical Sciences, BG Nagara, Nagamangala taluk, Mandya
district, Karnataka, India. |
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Address for Correspondence |
L22/A, 2nd
Cross, Pension Block,
Rajendra
Nagar,
Mysore - 570007, India.
E-mail:
drvijay195@yahoo.co.in |
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Vijay C, Mahendra Kumar KL, Manjappa CN, Deepak CD. Posterolateral Elbow Dislocation with Ipsilateral Fractures of Head and Distal End Radius. Online J Health Allied Scs.
2011;10(1):27 |
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Submitted: Feb 12,
2011; Accepted: March 31, 2011; Published:
April 15, 2011 |
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| Abstract: |
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Elbow dislocation
associated with ipsilateral fracture head and distal end radius is a
rare pattern of Injury, although it is common for elbow dislocation
and radius fractures to occur separately. We report a case of 35 year-old
male who had a posterolateral elbow dislocation with ipsilateral fractures
of head and distal end radius that underwent closed reduction and POP
application and outcome is excellent with 9 months of follow-up.
Key Words:
Elbow joint dislocation; Radial head; Distal end radius fracture; Closed
reduction
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Elbow dislocation
is commonly associated with fracture of proximal Radius and or ulna.
However, posterolateral elbow dislocation associated with ipsilateral
fracture head and distal end of radius is very rare.1,2
We Present an unusual pattern of fracture-dislocation of Forearm and
discuss the possible mechanisms of Injury and outcome with conservative
management.
A 35 years old
male presented to the outpatient office after falling down from a tractor
landing on his outstretched right hand with forearm pronated and elbow
slightly flexed. On physical examination, there was a swelling and gross
deformity at the right elbow and the forearm with unduly prominent olecranon
process. There was tenderness at both Proximal and distal end of radius
with no evidence of neurovascular compromise. Plain radiographs of elbow
and forearm with wrist AP & Lateral views revealed posterolateral
elbow dislocation with ipsilateral fracture head of the radius and extraarticular
fracture of distal end of radius (Fig. 1). Closed reduction was immediately
performed under sedation. A long arm cast was applied for immobilization
(Fig 2) and was converted to short arm cast
after 3 weeks, active elbow ranges of movements were started as tolerated
by the patient. 6 weeks later cast was removed and wrist forearm movements
were advised. Patient was on close follow up at monthly intervals.
At the end
of 6 months, the patient had regained painless range of movements of
the elbow, wrist and forearm with slight limitation of dorsiflexion
of wrist with terminal limitation of pronation and supination of the
forearm.
Plain radiographs
at 6 months showed union at the head and distal end of the radius (Fig.
3). As the patient was asymptomatic, he was advised to carryout with
his activities of daily living.
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Figure 1:
AP and lateral radiograph of the elbow and forearm showing posterolateral
dislocation of the elbow with ipsilateral fracture of head of the radius
and distal radius |
Figure 2:
AP and lateral radiograph of the elbow and forearm showing well reduced
dislocation of the elbow along with reduction of fracture of distal
and proximal radius. |
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Figure 3:
Radiograph showing united fracture distal and proximal end of the radius. |
The elbow
joint is one of the most stable hinge joint. Fractures associated with
elbow dislocation commonly occur around the elbow and involve the radial
head, olecranon, and coronoid process.3 Ulnar diaphyseal
fracture with radial head dislocation (Monteggia fracture dislocation)
is also a common pattern of injury.4
Few cases of elbow dislocation combined with ipsilateral Galeazzi
fracture and ipsilateral fracture dislocation of the radial
shaft head associated with elbow dislocation have been reported.5,6 The possible mechanism of injury in our case of such a
rare fracture dislocation is due to fall on an outstretched
hand from a height of about 6 feet most likely had
a fracture distal end of radius, then the posterolateral valgus load
at the elbow leading to elbow dislocation and capitulum hitting the
radial head leading to sagittal fracture of the head of radius
fracture. Only a few similar cases have been reported. Our case had
an excellent outcome with conservative management.
As elbow dislocation was well reduced, and radial head fracture was
a Masons type I marginal fracture which do not compromise the
stability of proximal radioulnar joint and forearm rotation7,8 along with acceptable reduction of distal
end radius fracture with radial height tilt and angulations being
maintained in the acceptable position9, so we did not plan for operative management.
Conservative
management by closed reduction and pop application would be adequate
for such fracture dislocation of the elbow provided fractures and dislocation
are reduced in acceptable position.
- Aufranc OE, Jones
WN, Turner RH, Thomas WH. Dislocation of the elbow with fracture of
the radial head and distal radius. JAMA. 1967 ;27;202(9):897-900.
Ahmad R, Ahmed
SM, Annamalai S, Case R. Open dislocation of the elbow with ipsilateral
fracture of the radial head and distal radius: a rare combination without
vascular injury. Emerg Med J. 2007;24(12):860
Ring D, Jupiter
JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am 1998;80:566–580.
Ring D, Jupiter
JB, Simpson NS. Monteggia fractures in adults. J Bone Joint Surg Am
1998;80:1733–1744.
Shiboi R, Kobayashi
M, Watanabe Y, Matsushita T. Elbow dislocation combined with ipsilateral
Galeazzi fracture. J Orthop Sci. 2005;10(5):540-542
Shukur MH, Noor
MA, Moses T. Ipsilateral fracture dislocation of the radial shaft head associated with elbow dislocation: case report.
J Trauma. 1995;38(6):944-946.
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.
Weseley MS, Barenfeld
PA, Eisenstein AL. Closed treatment of isolated radial head fractures.
J Trauma 1983;23:36-39.
Szabo RM. Extra-articular
fractures of the distal radius. Orthop Clin N Am 1993;24(2):229-237.
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