Lateral dislocation of the elbow joint accompanied by a supracondylar/intercondylar humerus fracture in an adult

Abstract

Elbow dislocations are frequently affiliated with a variety of fractures involving the ulna and radius. 2,4,5 To our knowledge, the literature contains no record of adult elbow dislocation occurring in association with a fracture of the distal humerus. We report a case of a right elbow dislocation in an adult associated with an open fracture in the distal portion of the ipsilateral humerus. Case reportA 43-year-old male arrived in the emergency department after falling from a height of 20 ft onto a concrete surface. Identified injuries included: a right elbow dislocation associated with an open supracondylar/intercondylar humerus fracture ( Fig. 1), an acetabular fracture, and fractures of both right and left distal radii. No other injuries were diagnosed. The patient was taken to the operating room for irrigation, debridement, and fracture stabilization.The patient was placed in the supine position and general endotracheal anesthesia was administered. A standard posterior incision was made through the skin, down to the level of the fascia, starting over the proximal one-half of the ulna and extending to the mid portion of the humerus. A standard olecranon chevron osteotomy was performed and the humerus exposed.The distal humerus fragment was displaced medially. The ulnar nerve was maintained in the cubital tunnel, in a normal position with respect to the medial epicondyle. All elbow ligaments were clearly disrupted. Inspection of the joint revealed an intercondylar split in the humeral trochlea. The fracture hematoma was evacuated and debris was removed from the laceration. Devitalized tissue including ragged edges was sharply excised. The wound was irrigated with copious normal saline using a pulse lavage system. The fracture was repaired using interfragmentary screws and a buttress plate fixation. The ulnar nerve was transposed to avoid later irritation of the nerve by the plates. Following reattachment of the olecranon osteotomy the elbow joint was reassessed. As expected, it was unstable to valgus stress, but remained stable through an arc of flexion and extension. The surgical and traumatic wounds were reapproximated, sterile dressing applied, and the patient placed in a posterior splint.

Lateral Condyle Fracture Dislocation of the Elbow Joint in an Adult: A Rare Case Report

“…Complex elbow dislocations are well studied in the literature with an annual incidence of 1.6 per 100,000 in children and adults [15]. However, fracture dislocation of the humeral condyle which is a described entity in the pediatric population is very rarely seen in the adult population [3][4][5][6]. Even large published studies have not reported this pattern of injury.…”

“…However, Fracture-dislocation of the humeral condyle, which is usually seen in the pediatric population is very rare in adult population [3]. There are very few published reports recognizing such an entity in the adult population [4][5][6]. Even in a large case series of 503 fractures of the distal humerus, fracture dislocation of the humeral condyle was not reported [7].…”

“…Such is the rarity of these lesions that a defined plan of management has not been established [4]. Management of complex elbow dislocations requires reduction of dislocation, osteosynthesis of fracture and ligamentous repair [8].…”