A case report of children's divergent dislocation of the elbow and review of literature

Abstract

Background:The divergent dislocation of the elbow is not common in children, and the imaging is difficult and challenging. This often leads to misdiagnosis or inappropriate treatment. The literature has reported a total of 19 cases currently.Methods:A 10-year-old girl with divergent dislocation of the elbow was admitted in our department in November 2013. When playing basketball, her right elbow was injured on the concrete floor. After injury, her right elbow joint became severely swollen, with obvious deformity. The anteroposterior X-ray of elbow showed right olecranon and coronoid fractures, the proximal radioulnar separation, and displacement; the lateral X-ray showed the posterior dislocation of right elbow.Results:Under local anesthesia, right elbow manual reduction was performed, and after reduction, 3-dimensional computed tomography reconstruction displayed good reduction of the elbow dislocation. The fracture of coronoid displaced minimally, but the olecranon fracture showed great displacement which underwent the open reduction and internal fixation. Postoperatively, a plaster splint was applied for protection, with regular outpatient follow-ups. At the end of the normal follow-up, the active ROM of the right elbow joint was 5° to 130° and with normal rotation.Conclusion:Therefore, through the treatment of this case and the literature review, we believe that for children, most divergent dislocations of the elbow may achieve a better clinical result with closed reduction, and we also believe that after surgery or closed reduction, in the follow-up, proper function exercise is an important condition for the rehabilitation of children. For such patients, correct diagnosis and timely treatment can help to avoid joint dysfunction of elbow.

Divergent Dislocation of the Elbow in an Adult with Ehlers–Danlos Syndrome

“…Injuries to the annular ligament and medial collateral ligament were common soft-tissue complications. Although several cases were treated with closed reduction, 10 cases required open surgery to treat fractures or dislocation [9][10][11][12]16,25,27,31,33,34 . Annular ligament, capsule, and bone fragment from the fracture site were commonly listed as reduction-inhibitory factors.…”

“…In 1981, DeLee 1 reported the first modern case of divergent elbow dislocation confirmed by radiographs in a child. Since then, there have been 30 reported cases of traumatic divergent dislocation, of which only 4 were in adults 9-12 and the remaining were in children (Table I) 1,13-34 .…”

Divergent Elbow Dislocation Associated with Ipsilateral Fractures of Ulnar Diaphysis and Radial Styloid Process in Adult: A Case Report

“…The previously reported cases of transverse divergent dislocations of the elbow occurred in children [ 6 , 7 ]. Elbow dislocations are usually associated with fractures around the elbow joint such as epicondylar fractures, radial head fractures, or coronoid fractures.…”

Traumatic divergent dislocation of the elbow in the adults

“…To our knowledge, the first modern case of traumatic DDE was reported by DeLee in 1981 [ 1 ]. Since then, thirty-one cases were identified in reported studies, of which only five clinical literatures investigated this injury in adults [ 1 – 28 ]. Most of these studies mentioned that conservative treatment could acquire great clinical outcomes.…”