Irreducible posterolateral elbow dislocation: a rare injury

Abstract

Posterolateral dislocation of the elbow is an injury commonly treated in the emergency department by closed reduction. Very rarely it can be irreducible and require open reduction. Only four cases of irreducible posterolateral elbow dislocation have been described in the literature over the past 50 years. We report the case of a 20-year-old man who sustained such an injury. Open reduction was performed and revealed the radial head protruding or 'buttonholing' through the lateral collateral ligament complex. This case highlights that continued closed reduction of the elbow should not be attempted, as a mechanical block to reduction can occur making reduction impossible.

Irreducible posterolateral elbow dislocation: A case report

“…In very rare cases, an associated fracture with fragment interposition may render the dislocation irreducible [2] . However, there are a few cases of isolated irreducible dislocation of the elbow described in the literature [3] , [4] , [5] , [6] , [7] , [8] . Fenelon et al report that only four cases have been described in the literature in the last 50 years [7] .…”

“…However, there are a few cases of isolated irreducible dislocation of the elbow described in the literature [3] , [4] , [5] , [6] , [7] , [8] . Fenelon et al report that only four cases have been described in the literature in the last 50 years [7] . Open reduction shows in most cases blockage by the joint capsule or the complex ligaments or transbrachialis Buttonholing of the radial head [4] , [6] , [7] , [8] .…”

“…Fenelon et al report that only four cases have been described in the literature in the last 50 years [7] . Open reduction shows in most cases blockage by the joint capsule or the complex ligaments or transbrachialis Buttonholing of the radial head [4] , [6] , [7] , [8] . As in our patient's case, the radial head caught in a “sandwich” or buttonhole appearance in the ligament complex and the joint capsule.…”

Irreducible Elbow Dislocation Associated with Hill?Sachs-like Lesion over the Capitellum

“…Most irreducible elbow dislocations are caused by interposition of soft tissues, such as brachial muscles and collateral ligaments. These dislocations are also caused by the radial head protruding or buttonholing through the lateral collateral ligament complex [ 3 ]. An avulsion fracture is another cause of irreducible elbow dislocation, and the avulsed fragment may be entrapped in the joint space, thus making reduction unavailable [ 4 ].…”

“…Most elbow dislocations are treated with closed reduction. Few literature reports are available on irreducible elbow dislocations, and these mostly describe soft-tissue interposition [ 2 , 3 ]. In the current case report, we present the rare case of a 67-year-old woman with an irreducible posteromedial elbow dislocation associated with a Hill–Sachs-like lesion over the capitellum.…”