|Year : 2018 | Volume
| Issue : 4 | Page : 237-239
A rare combination of elbow dislocation and radiocarpal fracture dislocation
Siddhart Yadav1, Vikram Khanna2, Sunirmal Mukherjee1
1 Department of Orthopaedics, Apollo Hospitals, Navi Mumbai, Maharashtra, India
2 Department of Orthopaedics, Ranjana Hospital, Allahabad, Uttar Pradesh, India
|Date of Web Publication||5-Dec-2018|
Department of Orthopaedics, Ranjana Hospital, Allahabad, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
A 31-year-old male came to the hospital with ipsilateral radiocarpal fracture dislocation and elbow dislocation. Elbow was reduced immediately in the emergency, and the open reduction and internal fixation with plating were done for the radiocarpal fracture dislocation. The patient recovered with a good range of motion of both elbow and wrist. This combination of fracture is rare with the possible mechanisms being single impact due to the fall from a height on an outstretched hand or double impact on the elbow and the wrist.
Keywords: Distal-end radius plating, elbow dislocation, radiocarpal fracture dislocation
|How to cite this article:|
Yadav S, Khanna V, Mukherjee S. A rare combination of elbow dislocation and radiocarpal fracture dislocation. Apollo Med 2018;15:237-9
| Introduction|| |
Elbow dislocation closely follows shoulder dislocation as being the second most common dislocation in adults., Elbow dislocation may be simple or complex. Simple is dislocation without fracture, just a capsuloligamentous injury, whereas complex dislocation consists of fracture dislocation of the elbow. Radiocarpal fracture dislocation is a rare high-energy injury which may be seen as a result of severe crush or rotation injury to the carpal bones due to either fall from a height, high-speed motor accidents or industrial accident.
In general, complexed fracture dislocation of elbow consists of involvement of proximal radius or ulna, and fracture dislocation of the radiocarpal joint is rare. In our extensive search of the literature, we found only a few cases of distal radius involvement with elbow dislocation and that too with a fracture of the distal-end radius.,
Here, we present a case report of elbow dislocation along with radiocarpal fracture dislocation.
| Case Report|| |
A 31-year-old male came to the hospital with complaints of pain and deformity in the left elbow and wrist. The patient gave a history of falling from a stool while changing a light bulb. On examination, the left elbow was deformed, and there was swelling seen on the left wrist along with the deformity. There was tenderness elicited on both the elbow and the wrist. Elbow and wrist range of motion were painful and restricted. There was no distal neurovascular deficit.
X-rays showed left elbow posteromedial dislocation along with left radiocarpal fracture dislocation [Figure 1]. Both the elbow and the wrist were reduced under general anesthesia immediately. Gentle traction was given on the proximal forearm in flexion thereby reducing the elbow; the wrist was then reduced with traction; splint was given in the form of above elbow plaster slab; and the patient was admitted. Postreduction the elbow was found to be stable and was not subluxating.
After 2 days, the swelling in the distal radius reduced, and the patient was taken up for open reduction and internal fixation (ORIF) of distal-end radius with volar plating. A volar incision was given over the distal-end radius, and dissection was done in between the flexor carpi radialis and the radial artery. Flexor pollicis longus tendon was identified and then retracted medially. Subperiosteal dissection of the pronator quadratus was done, and the fracture was visualized and reduced under vision and C-arm. The plate was applied and fixed with screws [Figure 2].
In the postoperative period above elbow plaster slab was applied for 4 weeks. The range of movement was started after that, and the patient was allowed full function of the limb after 8 weeks. There was no complication in the intraoperative or the postoperative period. The distal radius fracture united, and there was no episode of any redislocation of the elbow. At 3-month postoperative follow-up period, the patient attained 70° of flexion of the wrist and 25° of extension at the wrist. The wrist showed full supination and pronation [Figure 3]. The flexion and extension increased at 6-month postoperative with a deficit of 20° of extension of the wrist. X-rays showed healed fracture with the articular surface maintained and the plate in situ [Figure 4].
| Discussion|| |
The elbow joint is one of the most stable joints in the body. Elbow dislocation is generally associated with fractures of the distal humerus or the proximal radius or ulnar. Elbow dislocation along with shaft radius or ulnar fracture has also been described in the literature.
The association of the elbow dislocation with radiocarpal fracture dislocation is rare. The cases reported like this are in the pediatric age group.,,,, The mechanism of injury for such an injury may be either due to a single impact due to falling from a height on an outstretched hand or double impact first on the ground causing the radiocarpal fracture dislocation and the second impact causing the ulnohumeral dislocation. In this case, the mechanism was the initial one. The force on the outstretched hand caused the fracture dislocation of the radiocarpal joints whereas the massive force on a hyperextended elbow caused the posterior dislocation of the ulnohumeral joint [Figure 5].
|Figure 5: Patient enacting the mechanism of injury. How he was changing a light bulb on a stool and fell down on an outstretched hand|
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The elbow joint can be easily reduced under sedation, and in this case, it was found to be stable. For the fracture dislocation of the radiocarpal joint, ORIF was done to encourage early mobilization. The final union result was good and without any complications.
| Conclusion|| |
Elbow dislocation with ipsilateral radiocarpal fracture dislocation is rare. The mechanism of injury should be kept in mind to look for such associated injuries.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]