Journal of Postgraduate Medicine
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CASE REPORT
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Year : 1997  |  Volume : 43  |  Issue : 1  |  Page : 19-20  

Irreducible lateral dislocation of the elbow.

M Chhaparwal, A Aroojis, M Divekar, S Kulkarni, SV Vaidya 
 Department of Orthopaedics, King Edward Memorial Hospital, Parel, Mumbai.

Correspondence Address:
M Chhaparwal
Department of Orthopaedics, King Edward Memorial Hospital, Parel, Mumbai.

Abstract

A rare case of an irreducible post-traumatic lateral dislocation of elbow is presented. The mechanism of injury was fall on a flexed elbow with trauma on its medial aspect resulting in pronation of the forearm. At open reduction, the brachialis muscle was in the form of a tight band which prevented reduction. The ulnar nerve was entrapped in the joint.



How to cite this article:
Chhaparwal M, Aroojis A, Divekar M, Kulkarni S, Vaidya S V. Irreducible lateral dislocation of the elbow. J Postgrad Med 1997;43:19-20


How to cite this URL:
Chhaparwal M, Aroojis A, Divekar M, Kulkarni S, Vaidya S V. Irreducible lateral dislocation of the elbow. J Postgrad Med [serial online] 1997 [cited 2021 Dec 7 ];43:19-20
Available from: https://www.jpgmonline.com/text.asp?1997/43/1/19/419


Full Text




  ::   IntroductionTop


Elbow dislocations more commonly occur posteriorly[1]. Anterior dislocations are usually associated with a fracture of the olecranon. Lateral dislocations are rare and are generally associated with severe soft tissue damage. Linscheid and Wheeler[2] in their series of 110 cases of dislocation of elbow reported only two lateral dislocations (1.8%). Kini[3] reported two cases of lateral dislocation in his series of 60 patients (3.3%).


  ::   Case reportTop


A 21-year-old male, manual labourer, fell off a bullock-cart from a height of about six feet, with a resultant impact on the flexed left elbow. He had attempted pronation in order to support himself. Following this fall, he noticed a deformity of his left elbow, and was brought to the hospital about 12 hours after the injury. On examination, the elbow was widened, the olecranon was displaced laterally along with the radial head, which was anterior to the lateral humeral condyle. The lower end of the humerus was palpable on the medial aspect. The elbow was in 30 degree flexion and the forearm was in pronation. Any attempted movements were painful. The ulnar nerve was found to be nonfunctional with absent sensations over the medial one and half digits on the volar aspect and the medial three and half digits dorsally. There was complete paralysis of the flexor carpi ulnaris, ulnar half of the flexor digitorum profundus and the intrinsic muscles of the hand.

X-ray of the left elbow in true antero-posterior plane was not possible. Attempted antero-posterior, lateral and oblique views revealed a lateral dislocation of the elbow with chip fractures of the coronoid process and the lateral part of the capitellum. The radial head was anterior to capitellum and coronoid process faced the lateral aspect of the capitellum [Figure:1].

A closed reduction was attempted 20 hours after injury, under general anaesthesia, using traction and pressure over the displaced olecranon. Despite two attempts, reduction was not achieved and hence the patient was taken up for an open reduction through a posterolateral incision. The triceps was incised vertically and the elbow joint was opened. On exploration the medial capsule was torn, and the ulnar nerve was found to be entrapped between the ulna and the lateral condyle of the humerus [Figure:2]. The chip fracture of the coronoid process was visualized and the capitellar fracture was found to be non-articular. The nerve was isolated proximally upto the medial intermuscular septum and distally upto the flexor carpi ulnaris. The intraarticular fractured piece of the coronoid was removed. The brachialis muscle was found to be a tight band and it prevented reduction. On the release of this band, reduction was achieved easily. The ulnar nerve was transposed anteriorly and the torn medial collateral ligament was reattached to the medial epicondyle. The elbow was placed in a posterior splint in 90 degree flexion for a period of two weeks.

The patient was started on active range of motion exercises at the end of two weeks and had a range of motion of five to 120 degree at the end of six weeks. The ulnar nerve function was recovering at the time of reporting. A fresh X-ray did not reveal evidence of myositis ossificans [Figure:3].


  ::   DiscussionTop


Lateral dislocation of the elbow is a rare entity. A true lateral dislocation is one in which the articulating surfaces of the forearm bones maintain their relative position to the transverse axis of the lower end of the humerus, without anterior or posterior displacement. Speed[4] described three varieties of lateral dislocations - complete with pronation of the forearm, complete without pronation of the forearm, and incomplete dislocation. The mechanism of injury is trauma to the medial aspect of the elbow with pronation of the forearm as occurred in our case. However, due to the severe damage to capsulo-ligamentous structures in lateral dislocations, reduction is usually achieved easily. The presence of intraarticular fragments avulsed from the medial epicondyle or the lateral condyle especially in children may prevent reduction[5]. Of the two reported cases of irreducible lateral dislocation of the elbow, Exarchou[6] reported anconeus as the cause of the failure of closed reduction while Smith[7] reported brachialis as the cause of the failure in his case. The chip fractures of the coronoid and the capitellum were caused by impaction of the coronoid process on the capitellum. Fracture of the capitellum has also been reported by Smith in his case. Speed[4] described damage to the ulnar and radial nerves either by laceration or stretch in lateral dislocations. There is no report of entrapment of the ulnar nerve in these cases.

References

1 DeLee JC, Green DP, Wilkins KE. Fractures and Dislocations of the Elbow. Rockwood CA Jr., Green DP, editors. Fractures in Adults, 2nd Edition. Philadelphia: JB Lippincott Company; 1984, pp 601.
2Linscheid RL, Wheeler DK. Elbow Dislocations. JAMA 1965; 194: 1171.
3Kini MG. Dislocation of the elbow and its complications. J of Bone and Joint Surg 1940; 22:107.
4Speed K. Dislocations at the Elbow, in: A Textbook of Fractures and Dislocations, 3rd Edition, Philadelphia: Lea and Febiger; 1935, pp 509.
5Vijaya S. Lateral dislocation of elbow joint. Singapore Med J 1966; 7:139.
6Exarchou EJ. Lateral dislocation of the elbow. Acta Ortop Scand 1977; 48:161.
7Smith MF. Surgery of the elbow. Springfield, Illinois: Charles C Thomas; 1954, pp 233.

 
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