Spontaneous divergent elbow dislocation after Sauve-Kapandji procedure

This is a report on an unusual complication of the Sauve-Kapandji procedure in patients with rheumatoid arthritis. Two women with rheumatoid arthritis who previously had an ipsilateral Sauve-Kapandji procedure experienced spontaneous transverse divergent elbow dislocations without evident trauma. Their radiographs showed medial dislocation of the proximal ulna, which was separated from the radial head. The radial head and distal end of the ulnar shaft showed remarkable instability by a pronation and supination motion without the radial and ulnar shafts being separated from each other. Stress radiographic examination showed significant loosening of all ligaments except the medial collateral ligament around the elbow and did not show disruption of the interosseous membrane. A unique chronic twist radioulnar dissociation which consists of gross instability of the radial head and the distal ulna without disruption of the interosseous membrane was considered to cause instability of the humeroulnar joint, which results in medial dislocation of the proximal ulna. This report suggests that there is a direct cause and effect relationship between the residual distal ulnar instability and the development of transverse divergent dislocation of the elbow in patients with rheumatoid arthritis after the Sauve-Kapandji procedure.     

Complex elbow dislocation associated with radial and ulnar diaphyseal fractures: a rare combination

We illustrate a rare complex dislocation of the elbow involving a posterior ulno-humeral dislocation associated with open diaphyseal fracture of the ulna, radial shaft fracture, Type 1 coronoid fracture and neuropraxia of the deep branch of the radial nerve. The isolated ulno-humeral dislocation without radio-capitellar involvement, and ulnar diaphyseal fracture, makes this “reverse Monteggia” type of injury pattern very unique. This patient was managed with an initial reduction of his ulno-humeral joint and stabilization of his radius and ulna fractures. He underwent a delayed medial collateral ligament reconstruction a few days later. His fractures went on to unite fully, his elbow joint remained stable, and he achieved good range of motion of his elbow.     

Divergent elbow dislocation with radial shaft fracture,distal ulnar deformation,and distal radioulnar joint instability: an unclassifiable Monteggia variant

Originally described by Monteggia and later classified by Bado, elbow dislocations with concurrent radial and ulnar shaft fractures with distal radioulnar joint (DRUJ) disruption are considered operative cases with high-energy injurious etiologies. Here, we present an unclassifiable Monteggia variant fracture suffered through a high axial load mechanism in a 47-year-old female. The fracture pattern initially exhibited included a divergent elbow dislocation, a radial shaft fracture, plastic deformation of the distal ulna, and DRUJ instability. Here we describe the pattern in detail, along with definitive treatment and clinical outcome at 1 year follow-up.     

Ipsilateral radial shaft, head, and medial epicondyle fractures

A patient with a unique combination of ipsilateral midradial shaft (AO/OTA 22-A2), radial head (21-A2), and medial epicondyle (13-A1) fractures, without a recorded elbow dislocation or distal radioulnar joint disruption, is presented. The injury was treated surgically with a dorsal approach to the forearm and a lateral approach to the elbow through a single dorsolateral skin incision. The radial shaft fracture was stabilized using a 3.5-mm limited contact, dynamic compression plate; the radial head, using a 1.2-mm Luhr plate; and the medial epicondyle, using a partially threaded cancellous screw through a limited medial approach. The shaft fracture consolidated by 10 weeks, whereas radiographic consolidation of the radial head fracture was seen at 7 months. At the 15-month follow-up, the patient had achieved an excellent functional result. Awareness of the possibility of double injuries even in yet-unrecognized patterns is warranted when evaluating forearm and elbow trauma.     

Anterior elbow dislocation with potential compartment syndrome: a case report

Anterior elbow dislocation is an infrequent lesion, usually produced by direct trauma to the proximal ulna after a fall on the elbow in flexion, and is often associated with soft tissue injuries. The authors report a case of a complex injury produced by a high-energy trauma in the right arm of a 65-year-old patient. His limb was trapped inside an industrial spin-dryer, resulting in a closed anterior elbow dislocation, diaphyseal ulnar shaft, radial styloid process fractures, and an associated compartment syndrome. The injury mechanism and its treatment are described to better manage the soft tissue injury and early elbow mobilization using the FEARM hinged external fixator. A good result was achieved, with almost complete restoration of the patient's arm functions, and he has returned to his previous working activities.     

Posterior dislocation of the ulna at the elbow with associated fracture of the radial shaft

An exceptional case of posterior dislocation of the ulna at the elbow, associated with fracture of the radial shaft, is reported. Diagnosis was established with anteroposterior and lateral radiographs of the forearm, elbow and wrist. Treatment consisted of closed reduction of the ulnar dislocation and open reduction and internal fixation of the radius with an AO plate. A long arm cast was applied for 3 weeks with the elbow held at 90 °. Six months later full function of the limb had been achieved.     

Isolated radial shaft fracture with unreducable posterior dislocation of the radial head and rupture of the lateral collateral ligament: A case report

Combined injuries associated with forearm shaft fractures and elbow dislocations are well recognized. We describe an uncommon case of an isolated radial shaft fracture with an unreducable posterior dislocation of the radial head and associated rupture of the lateral collateral ligament of the elbow.     

Traumatic dislocation of the radial head associated with ipsilateral fracture of the radial shaft: a case report

Ipsilateral radial head dislocation with radial shaft fracture is a rare injury. A few cases have been reported in the literature. We report the case of a 39-year-old man who presented with a radial shaft fracture and ipsilateral dislocation of the radial head caused by hyperpronation trauma of the forearm with hyperflexion of the elbow. The dislocation was reduced by manipulation after open reduction of the radial shaft fracture, which was then fixed with a plate. The clinical and radiological outcome was good with 2 years follow-up.     

Lateral condylar fracture and ipsilateral ulnar shaft fracture: Monteggia equivalent lesions?

Displaced ulnar shaft fractures are frequently associated with radiohumeral dislocation, producing the Monteggia fracture-dislocation. Fractures not previously thought to coexist were seen in a young boy following a severe automobile-pedestrian accident. The displaced ulnar shaft fracture was associated with a displaced lateral condylar fracture with preservation of the radiocapitellar joint and capsule. This fracture was treated with rigid internal fixation in spite of the open nature of the ulnar shaft fracture. This treatment permitted early range of motion of the elbow with early use of ambulatory aids for other associated injuries and an excellent follow-up at 13 months with a normal range of motion of the elbow.     

Elbow dislocation with ipsilateral diaphyseal forearm bone fracture: A rare injury report with literature review

Dislocation of the elbow along with shaft fractures of both bones of the ipsilateral forearm is a rare injury though elbow dislocation or fracture of the forearm bones may occur separately. Such injuries need a concentric reduction of the dislocation and an anatomical fixation of forearm bones for optimal functional outcomes. We report a case of elbow dislocation with fracture of the lateral condyle of the humerus along with fractures of shafts of the radius and ulna in a 44-year-old female. Closed reduction of the elbow and operative stabilization of all fractures were done with good clinical, radiological and functional outcomes in 2 years follow-up period. A significant degree of force is needed to produce a combined dislocation of a joint and fracture of bones around that joint and these complex injuries may be missed if the clinician is not aware of the possibility of such injuries. The fact that the previously reported cases had a posterolateral dislocation while our case had a posteromedial dislocation and a fracture of the lateral humeral condyle as well makes it unique in its presentation and worth reporting. We have also included an up to date literature review on this topic.     

Fracture and dislocation of snowboarder's elbow.

BACKGROUND: This study focuses on the analysis of snowboarding versus skiing injuries, especially fracture, dislocation, or both, of the elbow, based on 7 years of medical records and roentgenograms of patients injured at a ski-snowboard area, Mt. Zao National Park, and demonstrates the precise characteristics of snowboard injury in the elbow region. METHODS: A retrospective study of 1,445 injured snowboarders and 10,152 injured skiers was undertaken to assess both snowboarding and skiing injuries. Sixty-four cases of snowboarding injuries and 152 cases of skiing injuries were available for precise analysis of fracture, dislocation, or both, in the elbow region. RESULTS: Fractures, dislocations, or both, in the elbow were more frequently observed for snowboarders (30 of 64 cases, 46.9%) when compared with that for skiers (26 of 152 cases, 17.1%) (p < 0.001). The rate of dislocation with or without fracture of the elbow was also significantly higher for snowboarders (17 of 64 cases, 26.6%) than for skiers (8 of 152 cases, 5.3%, p < 0.001). Seventeen cases of elbow dislocation in snowboarding were all of the posterior type, which accompanied two coronoid process fractures and two radial neck fractures. Fractures of the coronoid process (five cases), radial head (one case), radial neck (five cases), olecranon (one case), proximal ulnar shaft (one case), and extension-type fracture of distal humerus (four cases) were the fracture types observed in the analysis. CONCLUSION: Posterior dislocation; fractures of coronoid process, radial neck, and radial head; and extension-type fracture of the distal humerus characterize the particular and frequent injury mechanism responsible for snowboarding trauma in the elbow region. Thus, snowboarding injury of the elbow is recognized as a severe injury and is characterized by a frequent risk of posterior dislocation, fracture, or both. The severity of elbow injuries in snowboarding mainly seems to be due to direct mechanical force on the elbow, receiving the full impact of falling down, combined with an outstretched hand and elbow extension, or with an outstretched hand and longitudinal thrust force, to the proximal radius and ulna and distal humerus.     

Secondary radial head dislocation and dysplasia of the lateral condyle after elbow trauma in children

We report five cases of a rare complication of childhood fractures of the elbow region. The complication consists of posttraumatic dissolution of the lateral humeral condyle followed by secondary radial head overgrowth and dislocation. The initial injuries ranged from displaced lateral condyle fractures (three patients) to a supracondylar fracture and an open elbow dislocation. Dysplasia of the lateral humeral condyle was first noted 1 to 4 years after the trauma (mean, 2.5 years) and seemed to be caused by removal of the displaced fracture fragment in one patient, and possibly by malfixation and repeated surgical procedures in the others. Because of loss of motion, ulnar nerve irritation, and cosmetic deformities, corrective osteotomies had to be performed in four patients and additional radial head removal in two patients.     

Posterior approach to the elbow preserving the extensor apparatus. Its value in the osteosynthesis of humerus plate fractures

The authors describe a median posterior approach of the elbow with preservation of the triceps mechanism in continuity. Such an approach provides an excellent exposure of the elbow and of the lower part of the humeral shaft which can be used for the osteosynthesis of complex supra and intercondylar fractures. This approach can also be extended to the midshaft of the humerus, the radial head and the ulnar shaft. The repair is easy and strong enough to allow a rapid rehabilitation.     

Dislocation of the elbow with ipsilateral forearm fracture. Six particular cases

Elbow dislocation associated with ipsilateral radial shaft fracture is an infrequent injury (nine cases reported in the literature). We present six new cases observed between 2006 and 2012, with an average age of 31 years and a mean follow-up of 18 months. The forearm fracture and ipsilateral dislocation of the elbow were probably caused by forearm hypersupination with extension of the elbow. The dislocation was reduced by manipulation before open reduction and osteosynthesis of the forearm fracture. Four elbows were stable after reduction; two markedly unstable elbows necessitated temporary humero-ulnar external fixation; one case needed a ligamentoplasty several months later. Despite the complexity of the traumatic lesion, the clinical and radiological outcomes were acceptable.     

Dislocation of the shoulder with fracture of the ipsilateral shaft of the humerus

Three cases of dislocation of the shoulder and ipsilateral fracture of the shaft of the humerus are reported. The literature is reviewed. It is suggested that X-ray films should be taken of the shoulder and elbow in all patients with fractures of the shaft of the humerus.     

下尺桡脱位合并桡骨头脱位的诊断与治疗

目的探讨下尺桡脱位合并桡骨头脱位的的诊断和治疗。方法本文报道的2个典型病例,一例是下尺桡背侧脱位同时合并桡骨头后脱位,另一例是下尺桡掌侧脱位合并桡骨头前脱位,均不合并尺桡骨干的骨折。用单纯桡骨头脱位或下尺桡脱位的机制不能很好地解释。对于急性损伤,应先在麻醉下试行闭合复位,如不成功可考虑切开复位。结果根据目前研究,“绞锁损伤”的机制能比较好得解释这种损伤,骨间膜在前臂两骨之间起到一个“枢轴”的作用。早期诊断和治疗能达到良好的效果。结论早期诊断和早期复位固定非常重要,需要和孟氏骨折、盖氏骨折或Essex—Lopresti损伤等相鉴别。     

Unstable elbow dislocation with coronoid process fracture associated with distal radius fracture: a case report and review of the literature

We present a case of distal radial shaft fracture associated with elbow dislocation and coronoid process fracture. The associated coronoid fracture was initially missed. Closed reduction of the elbow and open reduction with internal fixation of the radial fracture were achieved immediately after admission. Radiographic control 3 days later showed that the elbow was redislocated into the cast. A careful reevaluation of the radiographs disclosed the coronoid fracture. An anterior approach of the elbow permits to reduce and fix the coronoid process. In addition, a hinged external fixator was applied to maintain concentric elbow reduction, and to protect the coronoid fracture fixation and the capsulo-ligamentous healing, while early elbow motion was started. The final result at 10-year follow-up was excellent both clinically and radiologically. According to our knowledge, a similar presentation of distal radial shaft fracture with ipsilateral unstable complex elbow dislocation and fracture of the coronoid process has never been described in the previous literature.     

Ulnar fracture with late radial head dislocation: delayed Monteggia fracture

Monteggia fractures are rare but commonly discussed lesions, with increasing complications due to late diagnosis. This article describes a case of a Monteggia fracture with delayed dislocation of the radial head. Previous radiographs of a 2-year 8-month-old boy show complete fracture of the distal ulna, with no radial head dislocation. The radial head remained well positioned after 4 weeks. Seven years later, he sustained another arm injury. He was diagnosed with a hematoma but was later believed to have nursemaid's elbow. He presented to our institution 5 weeks after the injury, and the radial head was found to be chronically dislocated, indicating a displacement occurring sometime during the past 7 years. After failing conservative treatment, the patient underwent surgical repair. The annular ligament was reconstructed using a harvested triceps fascia band, and an ulnar osteotomy was performed. A review of the literature found few reports of delayed Monteggia fractures, which accounted the delayed dislocations to ulnar angulation. However, our patient showed minimal ulnar angular deformity. We propose that the initial fracture disrupted the annular ligament and the radial head spontaneously relocated prior to being seen, which put the radial head at risk for later dislocation. We present an alternative hypothesis of dislocation after fracture healing and report the longest known period of delay between fracture and dislocation.     

The “floating forearm” injury in a child: a case report

Abstract: The case of a eleven-year-old girl who had a fracture dislocation of the left elbow with entrapment of the ulnar nerve into the dislocated ulnar epicondyle anlage and unstable forearm fracture of the ipslateral upper extremity is described. This severe injury to the elbow and the ipsilateral forearm is termed “floating forearm” injury. The forearm was stabilized percutaneously and the elbow fracture dislocation, remaining unstable after internal fixation was treated with a pediatric elbow fixator with motion capacity. Electronic supplementary material The online version of this articlecontains supplementary material, which is available on SpringerLink     

桡骨远端骨折合并同侧肘关节损伤的手术治疗体会

目的探讨桡骨远端骨折合并同侧肘关节周围骨折或脱位的治疗方法,提高临床治疗效果。 方法回顾性分析本院自2012年1月至2016年10月收治的桡骨远端骨折合并同侧肘关节脱位或骨折病例22例。22例桡骨远端骨折中13例伴尺骨茎突骨折,3例伴尺骨远端骨折,2例伴舟状骨骨折。22例肘关节周围损伤中5例为尺桡骨近端骨折,3例为肱骨远端骨折,14例发生肘关节后脱位。 结果所有患者均获得随访,术后平均随访时间为13.6个月（11~26个月）,所有骨折均愈合,未发生感染。Cooney腕关节评分平均为92.5分（55~100分）,其中优13例、良7例、中1例、差1例。Mayo肘关节功能评分平均为87.5分（50~100分）,其中优10例、良8例、中3例,差1例。其中1例就诊时已出现骨筋膜室综合征,尺神经、正中神经、桡神经均损伤,肌肉部分坏死切除,功能恢复较差。 结论桡骨远端骨折合并同侧肘关节损伤多为高能量损伤,早期积极而恰当的处理能为患者二次手术提供良好的条件,结合积极的康复锻炼,能取得良好的治疗效果。