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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.


INTRODUCTION


The most common fracture associated with paediatric elbow dislocations is avulsion of the medial epicondylar apophysis, [1] though fractures of the radial head, [2,3] lateral condyle of the humerus, [4] Galeazzi fracture dislocation [5] 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.

CASE REPORT

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
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.


DISCUSSION

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.

REFERENCES

1.Rockwood CA, Jr, Beaty JH, Wilkins KE. Fractures in children, 4th edition. Lippincot Raven Philadelphia - New York. 3 : 844.

2.Popovic N, Gillet P, Rodriguez A, Lemaire R. Fracture of the radial head with associated elbow dislocation : results of treatment using a floating radial head prosthesis. J Or thop Trauma Mar-Apr. 2000; 14 (3) : 171-7.

3.Geissler WB, Freeland AF. Radial head fracture associated with elbow dislocation. Orthopaedics Jul. 1992; 15 (7) : 874-7.

4.Rovinsky D, Ferguson C, Younis A, Otsuka NY. Pediatric elbow dislocation associated with a Milch type I lateral condyle fracture of the humerus. J Orthop Trauma Aug. 1999; 13 (6) : 458-60.

5.Mezzadra A, Gusmeroli F, Tettamanzi M, Prestianni B, Molinari D. A rare injury to the upper limb : elbow dislocation combined with Galeazzi fracture dislocation. Ital J Orthop Traumatol Dec. 1991; 17 (4) : 567-72.


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