Elbow Dislocation

With Rang types III and IV, open reduction is required when the apophysis has become entrapped in the elbow joint following a dislocation (Fig. 18.16). Intra-articular fragments may be washed out and the ulnar nerve explored. In the case of elbow dislocation, if following reduction, the epicondyle is... 

By taking STM images of a smaller area, it was found that the spontaneous formation of ordered arrays of Ni islands is determined by the herringbone reconstruction of the Au(lll) surface. It is clear that the Ni islands locate at the elbows of the herringbone structure. A detailed study of the atomic-resolution STM image and the local atomic structure near the elbows indicates that at each vertex of the elbow, there is a dislocation. Energetically, the dislocation site is the most probable location for the nickel deposition to nucleate. 

The past medical history was significant for a dislocated left elbow at 6 months of age that resolved spontaneously, left femur fracture at 16 months of age that occurred while she was trying to pull up to stand, and chronic sinusitis due to an underdeveloped ethmoidal-sphenoid sinus (air-filled cavity in the skull behind the bridge of the nose). Her psychosocial development appeared normal. She was able to crawl and scoot but could not cruise yet. 

The elbow joint is a comparatively weak part of the body and a forceful blow can dislocate it. Grasp your opponent s wrist or forearm and pull it behind him, stiffening his whole arm (fig. 29). As... 

Clinical examination reveals a laterally swollen elbow, tender at the fracture site, which is increased by active flexion of the wrist. Interpretation of the AP and lateral radiographs depend on the degree of ossification of the capitellum and the extent of the displacement. The lesser the degree of ossification, the harder it is to assess the fidl extent of the injury. In infants, where there is no ossification of the distal humeral epiphysis, lateral condylar injury may be confused with physeal separation or dislocation of the joint Physeal separation is the conunonest of these injuries in infants less than 1 year old. Often the only sign of injury is a small sliver of displaced metaphyseal bone. 

The dislocated radial head is an easily missed lesion, not infrequently resulting in litigation. The forearm fracture is readily identified and attention is drawn away from the co-existing elbow injury. It is vital that for long bone fractures, the adjacent joints are both imaged and properly reviewed. 

Monteggia injuries occur most frequently between the ages of 5 and 7. Patients will generally complain of forearm and elbow pain. If the ulna is fractured, pain will be maximal in the arm and there may be swelling and deformity. The elbow will also be swollen. In 10%-20% of cases, a neuropraxia of the radial nerve will be present, particularly if the radial head is dislocated laterally or anteriorly. Most of these nerve injuries will recover within 6-9 weeks and intervention is not indicated unless there is no sign of clinical or electromyographic recovery at 6 months. 

A number of equivalent lesions have also been described. Commonest of these is the Type 1 variant Where the radial head is dislocated anteriorly but the ulna has plastic deformation rather than a fracture. Other variants include dislocations with associated radial neck fractures, olecranon fractures and dislocations of the ulnar-humeral joint. In some respects, the pulled elbow , commonly seen in infants, can also be considered a Bado I equivalent. The injury occurs when the elbow has traction applied, usually resulting in hyperextension and pronation. The radial head subluxes through the annular ligament but does not truly dislocate and radiographs are either normal or will show an effusion with elevation of the fat pads. 

When imaging any long bone injury, it is imperative to include both the joint above and the joint below. Whilst Galeazzi lesions are rare in children, Monteggia lesions are not uncommon. It should also be stressed that the joint must be imaged in two planes. The elbow may look normal on the AP view but dislocation of the radial head is readily appreciated on the lateral projection. A straight line drawn up the shaft of the radius should intersect the capitellum in both AP and lateral views, irrespective of the degree of flexion of the joint (Fig. 18.13). 

In acute presentations, the dislocated radial head can generally be reduced by closed means. Under general anaesthesia, the elbow is flexed to enable... 

The mechanism of this injury is usually a valgus force on an extended elbow, commonly following a fall. It is also seen in association with a dislocated elbow, and occasionally following a vigorous throw. 

Fig. 18.16. a Fracture of the medial epicondyle associated with dislocation of the elbow (type IV). b Image intensifier radiograph demonstrates reduction of the elbow but the epicondyle is stuck in joint rather than in an anatomical position - arrowed, c Epicondyle fixed in correct position. 

The radial head may also be displaced following dislocation of the elbow, either during dislocation or following subsequent reduction. 

Fractures of the radial neck maybe isolated injuries but can occur in association with medial epicondyle avulsions, fractures of the olecranon and dislocations of the elbow joint. 

Rarely, the radial head is completely displaced, often lying adjacent to the capitellum. This fracture can occur during the reduction of a dislocated elbow if there is an undisplaced radial neck fracture (Fig. 18.18). The radial head may be reduced by closed manipulation aided by manipulation with percutaneous K-wire. One should be careful to make sure that the reduced radial head is not rotated 180° (Wood 1969). 

Fig. 18.18. a,b AP and lateral radiographs of radial neck fracture displaced by reduction of the dislocated elbow. Radial head lies adjacent to the capitellum. c Intraoperative radiographs showing intramedullary nancy nail and percutaneous wire used to manipulate the femoral head, d Post reduction film... 

Childress HM (1975) Recurrent ulna nerve dislocation at the elbow. Clin Orthop 108 168-173 Evans MC, Graham HK (1999a) Olecranon fractures in children. J Pediatr Orthop 19 559-569 Evans MC, Graham HK (1999b) Radial neck fractures in children a management algorithm J Pediatr Orthop Part B 8 93-99... 

Fig. 24.14a,b. Dislocation of the elbow with lateral epicondyle fracture, treated by a humero-olecranial pin. The orthopedic hardware may be well analyzed on these VRT images with different degrees of opacity... 

Craniofacial malformation are common features of FAS, which impairs the normal development of the skull, jaws, teeth, nose, eyes, and facial skin. Sometimes variable anomalies of limbs and joints are present, including congenital hip dislocations, abnormalities of the toes, and inability to extend completely the elbows or metacarpal phalangeal joints. Cardiac malformations syndrome encompasses an atrial septal defect, a patent ductus arteriosis, and cardiac murmurs representing ventricular septal defects. Anomalies of external genitalia have also been noted. 

Elbow is one of the most complex articular anatomy of human joint. Distal humerus, Proximal radius, and Proximal ulna are three elbow joint bones which are connected by tendons, ligaments and muscles [1]. Most famous disease that can affect normal elbow s function is rheumatoid arthritis that weaken the function status of patient. Total elbow arthroplasty can be the best decision for those patients that has advance elbow dysfunction, regarding to relive the pain and restore the normal physiological function [2]. Like all other joint replacement some complication such as instability, loosening, dislocation, polyethylene wear and infection, has restricted the long term survivorship of Total elbow arthroplasty [3]. 

Between two different semi constraint and unconstraint elbow prosthesis, Semi constrained prosthesis has a polyethylene-metal loose-hinged device with intrinsic stability. Although this stability prevents bones unfavorable dislocation, but it permit to valgus-varus motion. As it is reported in literature, loosening and mechanical failure can be considered as the most complication for linked prosthesis [6,7]. 

Dynamic US of the elbow can be used to help demonstrate abnormal dislocation of the ulnar nerve, with or without snapping triceps syndrome. This finding typically occurs in the cubital tunnel, an osteofibrous tunnel formed by a groove between the olecranon and the medial epicondyle and bridged by the Osborn retinaculum. As described in Chapter 8, dynamic scanning during full elbow flexion can allow continual depiction of the intermittent dislo-... 

---