Posterior Divergent Dislocation of the Elbow in Children and Adolescents

Abstract

Divergent dislocation of the elbow is defined as a specific elbow dislocation in which the distal humerus is forced between the proximal radius and ulna, resulting in separation or divergence of the proximal forearm bones. This is an uncommon injury in children, with 14 cases reported in the last 23 years. The authors report three additional cases and the findings from cadaver elbow dissections in which the injury was reproduced. The authors propose that there is only one type of divergent dislocation, resulting from indirect forces transmitted to the elbow from a fall on the outstretched hand. The injury predominantly occurs in younger children because joint laxity is a predisposing cause. Early recognition, followed by a closed reduction and a 3- to 4-week period of cast immobilization, should result in a full recovery for most children.

Clinical and functional outcomes and treatment options for paediatric elbow dislocations: Experiences of three trauma centres

“…The mean age of those patients was 8.6 (range [6][7][8][9][10][11][12][13][14]. The most frequently seen additional injury was fracture of the medial epicondyle (20 patients), (Fig.…”

“…Most of these dislocations were posterolateral (59%). Anterior and divergent dislocations are usually rare [3,5,[7][8][9]. Anterior dislocation may occur from a direct blow to the posterior aspect of the elbow, with avulsion of the insertion of the triceps from the olecranon [10] whereas divergent dislocation is a rare subgroup of the posterior dislocation group [8].…”

Divergent dislocation of the elbow in a 3-year-old

“…This case is the 15th reported in the world literature in the last 23 years. 1 Our patient is the youngest of these 15 cases. The injury was diagnosed by clinical examination and plain radiographs.…”

Traumatic Isolated Posterior Elbow Dislocation: Pediatric case report

“…This age is the period when physis layer starts to close. In early childhood which is immature in terms of skeletal structure, bones are weaker than ligaments and a major trauma applied to elbow will result in bone injury rather than isolated elbow dislocation 12,13,14 . In conclusion, development of isolated elbow dislocation without distal humerus, proximal radius and epiphyseal separation of ulna is less common in young children this is especially encountered quite rarely in children under 5 years.…”

“…The most common type of elbow joint is posterior type and frequently non-dominant extremity is injured. Common mechanism is falling on strained arm 9,10,12 . Elbow dislocation mechanism in our case also occurred in the same way.…”