Combined Posterior and Convergent Elbow Dislocation in Adult: A Rare Case Report

Abstract

Introduction: Elbow dislocations are commonly encountered by orthopedic surgeons all over. Management is straightforward and the result is generally satisfactory. However, in a small subset, associated injuries like convergent or divergent dislocations at superior radioulnar joints are present. These associated injuries are often missed initially leading to their delayed treatment and suboptimal elbow function. We report one such rare case of Convergent dislocation at the elbow. Although reported from other parts of the world till date, there has been none reported from India. It is extremely rare in adults. Twenty-three cases in children and only two in adults stand reported so far in world literature. Thus, our reporting it could be the first report of convergent dislocation at the elbow from India. To the best of our knowledge, it is only the third reported adult case in world literature. Case Report: We describe a 68-year-old male visiting a local hospital with a history of fall from a two-wheeler. An initial radiograph revealed an obvious posterior dislocation of the elbow. Closed reduction was performed, and posterior above elbow slab was given. Patient presented to us 10 days later with persistent pain. Evaluation with radiographs confirmed reduction of ulno-humeral joint but translocation of the radius and ulna which is combined posterior and convergent elbow dislocation. Conclusion: Combined posterior and convergent elbow dislocation is a rare scenario. The rarity of these associated injuries is the reason for lack of awareness. We suggest careful scrutiny of pre-reduction anteroposterior radiographic view or 3D CT in suspected cases as well as X-ray/Carm anteroposterior view in extended position of elbow on the operation table immediately after reduction before slab application in every case of elbow dislocation. Significant difficulty was encountered in open reduction in our case. This could be attributed to buttonholing of the radial head through insertion of brachialis fibers. The reporting of this surgical difficulty is important because it will help the surgeon know it beforehand and the awareness would make the surgeon take appropriate measures well in time. Keywords: Convergent elbow dislocation, superior radioulnar joint, buttonholing.