Transcapsular Buttonholing of the Proximal Ulna as a Cause for Irreducible Pediatric Anterior Elbow Dislocation

Abstract

Anterior elbow dislocations in the pediatric population represent rare and sometimes difficult injuries to manage. Associated olecranon fractures are even more uncommon with limited literature existing on the topic. We present the case of a six-year-old male with a traumatic transolecranon anterior elbow fracture dislocation in whom closed reduction was prevented by buttonholing of the proximal ulna through the anterior joint capsule. This case of pediatric anterior elbow fracture dislocation provides insight into an uncommon and challenging injury complex.

A Case Report of Closed Reduction of Anterior Transolecranon Fracture Dislocation of Elbow in a Pediatric Patient

“…Closed reduction maneuvers may fail if an annular ligament is completely torn with anterior dislocation of olecranon and radial head [ 1 , 8 ]. Buttonholing of the radial head, in that case, may occur through the anterior elbow joint capsule, which may have to be released under vision, preferably via a lateral surgical approach [ 9 ]. The reduction can then be verified under fluoroscopy and stability can be checked.…”

Anterior elbow dislocation without fracture in an adult: a rare injury pattern

“…Closed reduction may be attempted once or twice under sedation or preferably under general anaesthesia and is mostly successful. However, if difficulty is encountered in achieving reduction under closed technique it is wiser to do exploration and open reduction as many authors have noted button holing of the radial head,9 medial epicondyle5 or proximal ulna,6 and entrapment of ruptured triceps muscle,10 or ligamentous complexes as hindrance to reduction. Associated brachial artery transection has been reported by Kailash and Shanmuganathan 11.…”

“…Majority of elbow dislocations are posterior and very few are anterior (0%–2.6%) 4 5. Anterior dislocations are commonly associated with periarticular fractures 2 6 7. It is also reported following previous surgeries or pre-existing deformities around the elbow and in Ehler Danlos syndrome 4 8.…”