Posterior dislocation of the elbow associated with fracture of the radial head and olecranon, and with medial collateral ligament disruption: A case report
© Chen et al; licensee BioMed Central Ltd. 2008
Received: 27 July 2008
Accepted: 19 September 2008
Published: 19 September 2008
Fracture dislocations of the elbow appear extremely complex. Identification of the basic injury patterns can facilitate management.
A 38-year-old male motor-vehicle driver who fell on his right elbow after an accident was suffering from posterior dislocation of the elbow, without coronoid fracture, and with fracture of the radial head and olecranon, and medial collateral ligament disruption, which was not associated with any vascular or neural injury.
Posterior dislocation of the elbow associated with fracture of the radial head and olecranon, and medial collateral ligament disruption may be a rare subgroup of elbow dislocation. We should pay more attention to medial collateral ligament injury with elbow dislocation.
Fracture dislocations of the elbow appear extremely complex. Identification of the basic injury patterns can facilitate management. The simplest pattern of elbow fracture dislocation is posterior dislocation of the elbow with fracture of the radial head. Addition of a coronoid fracture, no matter how small, to elbow dislocation and radial head fracture is called the "terrible triad of the elbow" [1, 2]. However, the present case highlights addition of an olecranon fracture to posterior dislocation of the elbow and radial head fracture. Medial collateral ligaments were also completely disrupted.
We resected the radial head and restored the medial column with a suture anchor, and fixed the olecranon with a tension band and lag screws. The patient received early functional treatment and obtained a good outcome. In type 3 fractures , the radial head is replaced with a modular implant. The emphasis is placed on restoring the height of the radial head. Since Morrey and colleagues published their cadaver studies [10, 11], the anterior band of the medial collateral ligament has been considered one of the most important stabilizers of the elbow. Their data suggest that the medial collateral ligament is the primary stabilizer of the elbow under valgus stress, with the radial head playing a less important, secondary role. According to clinical experience, it may be more appropriate to consider the functions of the medial collateral ligament and radial head as overlapping and complementary rather than hierarchical. A person with either an attenuated medial collateral ligament or an absent radial head can have difficulty performing activities that place a vigorous valgus stress on the elbow, such as throwing, but usually has little difficulty with normal daily activities. On the other hand, when the medial collateral ligament and radial head are injured simultaneously, the elbow can become very unstable and prone to subluxation or dislocation.
Therefore, it is more important to repair the medial collateral ligament for keeping the stability of the elbow than to restore the height of radial head. Accelerated functional treatment for elbow dislocation is important, as long periods of immobilization are not likely to be of any benefit.
Posterior dislocation of the elbow associated with fracture of the radial head and olecranon, and medial collateral ligament disruption may be a rare subgroup of elbow dislocation. We should pay more attention to medial collateral ligament injury in elbow dislocation.
Written informed consent was obtained from the patient for publication of the report and any accompanying images.
We thank the patient for the written consent to publish this case report. No funding was required for this study. We also thank Edanz with help with editing the manuscript.
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