BACKGROUND: Open dislocations are infrequent, often associated with damage to the neuro vascular structures. We present an unusual case of an open antero-lateral dislocation of the elbow, which was not associated with any vascular or neural injury. CASE PRESENTATION: A 34 year female dance instructor sustained an open dislocation of her elbow. Surgical exploration was undertaken. No major neurovascular injury was present. There was almost complete disruption of all the muscular and ligamentous attachments to the distal humerus and the proximal radius and ulna, which were not formally repaired during surgery. The elbow was found to be very unstable, and was placed in a back slab. The functional recovery was complete in about six months, the patient regaining full range of elbow movement. Elbow dislocations without associate fractures are adequately treated by manipulation and reduction, in spite of the almost complete disruption of the soft tissues around the joint

D Ring

DB Mains

FD Kharrazi

JO Sojbjerg

KA Riel

MM al-Qattan

O Lansinger

P Josefsson

English

PubMed

Crossref

Open antero-lateral dislocation of the elbow. A case report

Juan A Alonso

Bibas R Roy

David L Shaw

Springer - Publisher Connector

BioMed CentralBMC Musculoskeletal DisordersBMC Musculoskeletal Disorders 2002, 3Case report
Open antero-lateral dislocation of the elbow. A case report
Juan A Alonso*, Bibas R Roy  and David L Shaw
Address: Department of Orthopaedics and Trauma Surgery, Bradford Royal Infirmary, Bradford, UK
E-mail: Juan A Alonso* - antonio@alonso.co.uk; Bibas R Roy - bibsroy@bigfoot.com; David L Shaw - dlshaw@orthonet.org.uk
*Corresponding author
Abstract
Background: Open dislocations are infrequent, often associated with damage to the neuro
vascular structures. We present an unusual case of an open antero-lateral dislocation of the elbow,
which was not associated with any vascular or neural injury.
Case presentation: A 34 year female dance instructor sustained an open dislocation of her
elbow. Surgical exploration was undertaken. No major neurovascular injury was present. There
was almost complete disruption of all the muscular and ligamentous attachments to the distal
humerus and the proximal radius and ulna, which were not formally repaired during surgery. The
elbow was found to be very unstable, and was placed in a back slab. The functional recovery was
complete in about six months, the patient regaining full range of elbow movement. Elbow
dislocations without associate fractures are adequately treated by manipulation and reduction, in
spite of the almost complete disruption of the soft tissues around the joint.
Background
Elbow dislocation is a common injury, postero-lateral dis-
location being the commonest pattern of injury. Open
dislocations are infrequent, often associated with damage
to the neurovascular structures. These injuries and various
ways of dealing with them have been widely described in
the literature [1–3]. We present an unusual case of an
open antero-lateral dislocation of the elbow, which was
not associated with any vascular or neural injury.
Case presentation
A 34 year female dance instructor presented to the Acci-
dent and Emergency department having fallen on to her
right elbow sustaining an open dislocation of her elbow
(Figure 1).
On admission there was a palpable radial pulse and full
sensation in her forearm and hand. Radiographs revealed
this to be an anterolateral elbow dislocation (Figures 2
and 3). Surgical exploration was undertaken. The unin-
jured brachial artery, and ulnar and median nerves were
all visualised. There was almost complete disruption of all
the muscular and ligamentous attachments to the distal
humerus and the proximal radius and ulna. The joint was
relocated, the wound cleaned with saline lavage and pri-
marily closed without formal repair of muscular and liga-
mentous structures. The elbow was found to be very
unstable, and was placed in a back slab. The post opera-
tive period was uneventful.
The elbow was maintained in a splint for a four week pe-
riod after which gentle physiotherapy was started. The
functional recovery was complete in about six months,
the patient regaining full range of elbow movement (Fig-
ure 4).
Published: 4 January 2002
BMC Musculoskeletal Disorders 2002, 3:1
Received: 18 October 2001
Accepted: 4 January 2002
This article is available from: http://www.biomedcentral.com/1471-2474/3/1
© 2002 Alonso et al; licensee BioMed Central Ltd. Verbatim copying and redistribution of this article are permitted in any medium for any non-com-
mercial purpose, provided this notice is preserved along with the article's original URL. For commercial use, contact info@biomedcentral.comPage 1 of 3
(page number not for citation purposes)
BMC Musculoskeletal Disorders 2002, 3 http://www.biomedcentral.com/1471-2474/3/1Conclusions
Elbow dislocations without associate fractures are termed
'simple'. They are adequately treated by closed reduction,
in spite of the almost complete disruption of the soft tis-
sues around the joint. Cases of open dislocation of the el-
bow are uncommon. They are usually associated with
severe trauma, contact sports, road traffic accidents etc.
Posterior elbow dislocation is due to a combined valgus
and external rotatory stress to the semiflexed elbow, re-
sulting in a bilateral ligamentous injury [4]. Anterior el-
bow dislocations occur most often as a fracture-
dislocation in which the distal humerus is driven through
the olecranon [5]. Simple anterior dislocation does not
seem to be a well described injury
The stabilising structures of the elbow can be thought of
as a ring [6]. The trochlear notch surrounds almost 180
degrees of the trochlea, accounting for a large part of the
stability of the elbow joint. The ulno-humeral articulation
has been shown to be the most important stabiliser of the
elbow joint. The posterior column, the disruption of
which would be a prerequisite for anterior dislocation, is
formed by the olecranon, the triceps, and the posterior as-
pect of the capsule [6]. This would explain the rarity of
this injury.
In our patient the medial collateral ligament was found to
be disrupted at operation. Thus, the injury had also in-
volved the medial column, dislocating the joint in an an-
tero-lateral direction. Most authors recommend
accelerated functional treatment for simple elbow disloca-
tions [7], as long periods of immobilisation have not been
found to be of any benefit [8]. Surgical repair of the liga-
ments has been advocated, but there is little evidence that
the results of surgical repair of the ligaments are any better
than those of non-surgical treatment [9]. This case high-
lights the possibility of sustaining an extensive soft tissue
damage after a minor injury and illustrates how excellent
functional outcome can be achieved with a conservative
approach in this situation.
Figure 1
Clinical photograph of open elbow dislocation following a
simple fall
Figure 2
Postero-anterior radiograph of right elbow showing an
antero-lateral dislocationPage 2 of 3
(page number not for citation purposes)
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Competing interests
None declared.
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Figure 3
Lateral radiograph of right elbow showing an antero-lateral
dislocation
Figure 4
Clinical photograph showing the range of movements
achieved on the injured elbow six months after injuryPage 3 of 3
(page number not for citation purposes)


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Open antero-lateral dislocation of the elbow. A case report

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