Mane Akash Nagnath, Sourav Neel Kamal, Panchnadikar Vijay, Bhandari Abhijit, Venkatakrishna Karthic
Department of Orthopedic Surgery, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.
J Orthop Case Rep. 2023 May;13(5):49-54. doi: 10.13107/jocr.2023.v13.i05.3642.
Elbow dislocations are commonly encountered by orthopedic surgeons all over. Management is straightforward and the result is generally satisfactory. However, in a small subset, associated injuries like convergent or divergent dislocations at superior radioulnar joints are present. These associated injuries are often missed initially leading to their delayed treatment and suboptimal elbow function. We report one such rare case of Convergent dislocation at the elbow. Although reported from other parts of the world till date, there has been none reported from India. It is extremely rare in adults. Twenty-three cases in children and only two in adults stand reported so far in world literature. Thus, our reporting it could be the first report of convergent dislocation at the elbow from India. To the best of our knowledge, it is only the third reported adult case in world literature.
We describe a 68-year-old male visiting a local hospital with a history of fall from a two-wheeler. An initial radiograph revealed an obvious posterior dislocation of the elbow. Closed reduction was performed, and posterior above elbow slab was given. Patient presented to us 10 days later with persistent pain. Evaluation with radiographs confirmed reduction of ulno-humeral joint but translocation of the radius and ulna which is combined posterior and convergent elbow dislocation.
Combined posterior and convergent elbow dislocation is a rare scenario. The rarity of these associated injuries is the reason for lack of awareness. We suggest careful scrutiny of pre-reduction anteroposterior radiographic view or 3D CT in suspected cases as well as X-ray/Carm anteroposterior view in extended position of elbow on the operation table immediately after reduction before slab application in every case of elbow dislocation. Significant difficulty was encountered in open reduction in our case. This could be attributed to buttonholing of the radial head through insertion of brachialis fibers. The reporting of this surgical difficulty is important because it will help the surgeon know it beforehand and the awareness would make the surgeon take appropriate measures well in time.
肘关节脱位在各地骨科医生中都较为常见。治疗方法简单直接，结果通常令人满意。然而，在一小部分病例中，会存在诸如上尺桡关节汇聚或分离脱位等相关损伤。这些相关损伤最初常被漏诊，导致治疗延迟以及肘关节功能欠佳。我们报告了一例如此罕见的肘关节汇聚脱位病例。尽管到目前为止世界其他地区有相关报道，但印度尚无此类报道。在成年人中极为罕见。世界文献中迄今报道的儿童病例有23例，成人病例仅有2例。因此，我们的报道可能是印度首例肘关节汇聚脱位的报告。据我们所知，这仅是世界文献中报道的第三例成人病例。
我们描述了一名68岁男性，因从两轮摩托车上摔倒前往当地医院就诊。最初的X线片显示肘关节明显后脱位。进行了闭合复位，并给予了肘上后侧石膏托固定。10天后患者前来我们这里，仍持续疼痛。X线片评估证实尺肱关节已复位，但桡骨和尺骨发生移位，这是合并的后位和汇聚型肘关节脱位。
合并后位和汇聚型肘关节脱位是一种罕见情况。这些相关损伤的罕见性是导致认识不足的原因。我们建议，对于疑似病例，在复位前仔细审视前后位X线片或三维CT，以及在肘关节脱位的每例病例中，复位后立即在手术台上将肘关节伸展位拍摄X线片/术中透视前后位片，然后再应用石膏托。我们的病例在切开复位时遇到了很大困难。这可能归因于肱肌纤维插入导致桡骨头形成纽扣孔样改变。报告这一手术困难很重要，因为这将有助于外科医生提前了解，从而及时采取适当措施。
