Acute traumatic posterior elbow dislocation in children

Abstract

Traumatic posterior dislocation of the elbow is often associated with significant morbidity and incomplete recovery. The aim of this study was to retrospectively analyse the outcome of 33 children (median age 10.8 years). Patients underwent reduction and assessment of stability under general anaesthesia. Pure dislocations (n=10) were immobilized, whereas unstable fractures (n=23) were stabilized. Refixation of ligaments was performed if stability was not achieved by fracture stabilization alone. Immobilization was continued for 26 (pure dislocations) or 35 days (associated injuries), respectively. Results were excellent (n=9) or good (n=1) after pure dislocation. Results were excellent (n=15), good (n=7) or poor (n=1) in children with associated injuries. Accurate diagnosis, concentric stable reduction of the elbow as well as stable osteosynthesis of displaced fractures are associated with good results in children with acute posterior elbow dislocations.

Pure elbow dislocation in the paediatric age group

“…The youngest reported patient with pure elbow dislocation in the literature was an 18 month-old child [4]. Limited numbers of studies discussing pure elbow dislocation in the paediatric age group have been published in the literature [1,3,7,8,10,16]. Di Gennaro et al [20] reported that dislocation of the elbow in children was a benign injury in the majority of cases and had a good prognosis.…”

“…Posterior elbow dislocations comprise over 90 % of the cases [2,3,10]. Unusual types of dislocations, such as the terrible triad, divergent or convergent dislocations or with crossover of the radius and ulna, were also reported in the literature [13,17,21,22].…”

“…Di Gennaro et al [20] reported that dislocation of the elbow in children was a benign injury in the majority of cases and had a good prognosis. On the other hand, Leiber et al [10] concluded that traumatic posterior dislocation of the elbow was often associated with significant morbidity and incomplete recovery. The main purpose of the present study was to evaluate the clinical results and prognosis of pure elbow dislocations in the paediatric age group following non-surgical treatment.…”

“…Medial epicondyle avulsion has been reported as the most commonly encountered concomitant injury [1,3,7]. Only a limited number of pure elbow dislocations in the paediatric age group have been reported in the literature [1,4,[7][8][9][10][11][12]. Restoration of stability remains the mainstay of treatment [6].…”

“…Restoration of stability remains the mainstay of treatment [6]. Although traumatic posterior dislocation of the elbow has been reported as often prone to acute and chronic complications with significant morbidity and incomplete recovery, prognosis is generally good when properly diagnosed and treated without delay [6,10,13].…”