Weng Hung-Kai, Chang Wei-Lun, Yeh Ming-Long, Su Wei-Ren, Hsu Kai-Lan
Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Clin Shoulder Elb. 2019 Mar 1;22(1):37-39. doi: 10.5397/cise.2019.22.1.37. eCollection 2019 Mar.
Irreducible dislocation of the elbow is an uncommon event. We present the case of a posterolateral elbow dislocation after a fall injury in a 67-year-old woman. A closed reduction performed in the emergency department was unsuccessful since the limited passive range of motion resulted in difficulty to perform longitudinal traction and flexion. Computed tomography images showed that the posterolateral aspect of the capitellum was impacted by the tip of the coronoid process, thus appearing similar to the Hill-Sachs lesion in the humeral head. Subsequent open reduction of the elbow revealed the dislocation to be irreducible since the tip of the coronoid process had wedged into a triangular Hill-Sachs-like lesion in the capitellum. The joint was reduced by providing distal traction on the forearm, and main fragments were disengaged using digital pressure. At the 3-month follow-up, the patient reported no dislocations, and had an acceptable range of motion. Thus, we propose that to avoid iatrogenic injury to the joint or other nearby structures, irreducible dislocations should not be subjected to repeated manipulation.
肘关节不可复位性脱位是一种罕见的情况。我们报告一例67岁女性因跌倒受伤导致的肘关节后外侧脱位病例。在急诊科进行的闭合复位未成功，因为被动活动范围有限导致难以进行纵向牵引和屈曲。计算机断层扫描图像显示，肱骨小头的后外侧被冠状突尖端撞击，因此类似于肱骨头的希尔-萨克斯损伤。随后的肘关节切开复位显示脱位不可复位，因为冠状突尖端楔入了肱骨小头的三角形希尔-萨克斯样损伤中。通过在前臂提供远端牵引来复位关节，并使用指压分离主要骨折块。在3个月的随访中，患者报告无脱位，且活动范围可接受。因此，我们建议为避免对关节或其他附近结构造成医源性损伤，不可复位性脱位不应反复进行手法复位。
