COMPLEX ELBOW DISLOCATION IN A YOUNG
BOY: A Rare Injury of the Upper Limb
AG KULKARNI*, R WADE**, VV PRABHU***, RN KATRE****
*Sr. Registrar; **Jr. Registrar; ***Lecturer; ****Professor and Head of
Department, Dr. RN Cooper Hospital, Vile Parle (West), Mumbai.
The most common fracture associated with paediatric elbow dislocations is avulsion
of the medial epicondylar apophysis,  though fractures of
the radial head, [2,3] lateral condyle of the humerus, 
Galeazzi fracture dislocation  have been reported. We present
a case of paediatric posterior elbow dislocation association with segmental
fracture of ipsilateral radius and ulna. There have been no descriptions of
this injury in the literature.
A 15 year old boy came to our casualty with severe pain, swelling and deformity
of the right upper limb following a fall from height. Distal neurovascular status
was intact. X-ray revealed posterior dislocation of elbow with ipsilateral segmental
fracture of radius and ulna (Fig. 1 top). Dislocation was reduced with anteriorly
directed pressure on the olecranon at the same time giving counter pressure
on the humerus. X-rays confirmed reduction of both the dislocation as well as
the fractures (Fig. 1 bottom). A posterior above elbow slab in 90o flexion was
given and later converted into an above elbow cast after the acute phase. At
2 months follow up patient has almost full painless range of movement of the
elbow as well as of the forearm and wrist.
|Fig 1 : (top) X-ray showing
posterior dislocation of the elbow with
segmental fractures of ipsilateral radius and ulna. (bottom) X-ray
showing reduction of the dislocation as well as the segmental fracture.
This case is presented because of its mechanism of injury and rarity of incidence.
This particular injury occurred due to two separate impacts occurring sequentially
one after the other during the same fall. While falling from a height the patient
first fell on his right outstretched hand on the top edge of a fence wall (when
the elbow dislocated posteriorly) and then had an impact on his forearm once
he fell on the ground with his entire body weight on his forearm (causing segmental
fracture of radius and ulna). This is to highlight the point that the earlier
described fractures associated with elbow dislocations were as a result of the
same force causing the dislocation and hence accompanied posterior elbow dislocation
quite commonly, but this particular injury was the result of two separate impacts
occurring sequentially during the same accident.
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