Analysis of magnetic resonance imaging–confirmed soft tissue injury pattern in simple elbow dislocations

Luokkala, Toni; Temperley, David; Basu, Subhasis; Karjalainen, Teemu; Watts, Adam C.

doi:10.1016/j.jse.2018.08.010

Cited by 43 publications

(20 citation statements)

References 19 publications

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“…However, it must be noted that this study exhibits the major limitation that an analysis of 2-dimensional data sets was performed to reconstruct a complex 3-dimensional process. Luokkala et al recently published a further MRI study with 16 patients and similarly to the present study analyzed the injury pattern following confirmed ligamentous elbow dislocation [12]. In this study, most patients (12/16) had a posterolateral, 3 patients a posterior, and 1 patient a posteromedial dislocation.…”

Section: Discussionsupporting

confidence: 64%

Injury patterns following simple elbow dislocation: radiological analysis implies existence of a pure valgus dislocation mechanism

Schnetzke

Ellwein

Maier

et al. 2020

Arch Orthop Trauma Surg

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Introduction The aim of the present study was to analyze the injury pattern and thus the dislocation mechanism after simple elbow dislocation using radiographs and magnetic resonance imaging (MRI) data sets. Materials and methods The MRI data sets of 64 patients with a mean age of 44 years (18-77 years) were analyzed retrospectively. The inclusion criteria for the study were (1) radiograph with confirmed simple elbow dislocation, (2) low-energy trauma, (3) MRI of the affected elbow ≤ 3 weeks after trauma. The dislocation direction was determined using radiographs. The integrity of the lateral collateral ligament complex (LCLC), common extensor origin (CEO), anterior capsule (AC), medial collateral ligament (MCL), and common flexor origin (CFO) as well as the joint congruity were assessed based on MRI. Results 34 patients (53%) had a posterolateral, 26 patients (41%) a posterior, and 4 patients (6%) a posteromedial dislocation. LCLC and AC were affected in 64 out of 64 patients (100%). MCL was affected in 58 patients (91%). CEO were affected in 25 patients (39%) and the CFO in 20 patients (31%). In 11 patients (17%) the injury pattern was more pronounced medially than laterally (MCL, CFO, LCLC), with 2 of these patients exhibiting only a partial LCLC tear. All cases with joint incongruency (n = 12, 19%) showed CEO and/or CFO involvement. Conclusions Simple elbow dislocation leads to a very heterogeneous spectrum of soft tissue injury pattern. A small proportion of patients showed medially pronounced injury patterns. These findings strongly indicate existence of a "reversed Horii circle" with an underlying valgus mechanism (medial force induction) originating and continuing from medial to anterior.

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Section: Discussionsupporting

confidence: 64%

Injury patterns following simple elbow dislocation: radiological analysis implies existence of a pure valgus dislocation mechanism

Schnetzke

Ellwein

Maier

et al. 2020

Arch Orthop Trauma Surg

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“…In their study, soft tissue lesions were observed in 16 elbows on MRI, and the anterior capsule, medial collateral ligament, and lateral collateral ligament complex were found to be injured. 11 They found that complete ligamentous tears were found more on the medial side than on the lateral side. However, these previous studies only evaluated soft tissue injuries and disregarded the role of osteochondral lesions in patients with simple elbow dislocation.…”

Section: Discussionmentioning

confidence: 97%

Distribution of Osteochondral Lesions in Patients With Simple Elbow Dislocations Based on MRI Analysis

Kim

Kholinne

Kwak

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: The clinical relationship between osteochondral lesions and long-term outcomes and patterns in the elbow joint has not yet been established. A sole evaluation from plain standard radiography may underestimate the severity of bony lesions in patients with simple dislocations. It has been suggested that the mechanism of a posterior elbow dislocation could be inferred from the pattern of bony contusions and osteochondral lesions visible on magnetic resonance imaging (MRI) in patients with simple elbow dislocations. Purpose/Hypothesis: The purpose of this study was to describe the incidence and distribution of osteochondral lesions based on MRI findings in patients with simple elbow dislocations. We hypothesized that (1) osteochondral lesions are consistently found in patients with simple elbow dislocations and (2) the distribution and severity of osteochondral lesions may explain the mechanism of the simple elbow dislocation. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of 43 patients with simple elbow dislocations was performed in tertiary-level hospitals from January 2010 to August 2019. Two orthopaedic surgeons separately assessed the initial plain radiographs and MRI scans. Osteochondral lesions were evaluated and categorized based on whether they were located (1) on the lateral side (posterolateral capitellum and radial head; type 1) or (2) on the medial side (posterior trochlea and anteromedial facet of the coronoid; type 2). The severity of the osteochondral lesions was assessed according to the Anderson classification. Results: Of the 43 patients, 21 (48.8%) presented with osteochondral lesions on MRI. The type 1 pattern of osteochondral lesions was the most frequently observed on MRI in patients with simple elbow dislocations (69.8% of cases), and these were confirmed by simple radiography. Posterolateral capitellum osteochondral lesions were found in 13 patients. Among them, 10 (76.9%) were advanced-stage lesions (stages III and IV according to the Anderson classification). Conclusion: Osteochondral lesions were found on MRI after simple elbow dislocations at a rate of 48.8%. Osteochondral lesions in the posterolateral capitellum were associated with an advanced stage. Clinically, these findings may help surgeons in the diagnosis of osteochondral lesions and in determining how to manage patients with the progression of arthritic changes.

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“…The extent of individual injuries is thought to be dependent on the energy expended and the degree of displacement. Luokkala et al [ 25 ] evaluated 17 consecutive cases of stable simple elbow dislocations and evaluated similar soft tissue structures as this study: MCL, flexor-pronator muscle mass origin, anterior capsule, posterior capsule, LCL, and extensor muscle mass origin. In contrast to this study, however, complete anterior capsule tears were most common (12/17), followed by MCM and LCL tears (10/17, 9/17).…”

Section: Discussionmentioning

confidence: 99%

Common Extensor Complex Is a Predictor to Determine the Stability in Simple Posterolateral Elbow Dislocation: Analysis of MR Images of Stable vs. Unstable Dislocation

Cho

Kim

et al. 2020

JCM

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Simple posterolateral elbow dislocations (SPLED) may be treated nonoperatively using closed reduction, followed by controlled mobilization. However, the extent of soft tissue injuries might affect the choice of treatment, rehabilitation approach, and prognosis. The purpose of this study is to compare the characteristics of soft tissue injuries between patients with unstable and stable SPLED using MRI findings. Thirty MRIs of elbows with SPLED (unstable group (n = 15); stable group (n = 15)) were randomly reviewed by two experienced musculoskeletal radiologists. Soft tissue injuries were characterized as an intact, partial tear or complete tear for the: medial collateral ligament (MCL) complex, common flexor complex, lateral collateral ligament (LCL) complex, common extensor complex, anterior capsule, and posterior capsule. Moderate to substantial interobserver reliability and substantial to perfect intraobserver reliability were observed for medial and lateral complexes in SPLED. The proportion of soft-tissue injuries of the common extensor complex were significantly different between the unstable (four partial tears and 11 complete tears) and stable groups (11 partial tears and four complete tears). In conclusion, based on MRI findings, the degree of common extensor complex injuries may be a predictor of stability and help inform treatment decisions for SPLED.

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Analysis of magnetic resonance imaging–confirmed soft tissue injury pattern in simple elbow dislocations

Cited by 43 publications

References 19 publications

Injury patterns following simple elbow dislocation: radiological analysis implies existence of a pure valgus dislocation mechanism

Injury patterns following simple elbow dislocation: radiological analysis implies existence of a pure valgus dislocation mechanism

Distribution of Osteochondral Lesions in Patients With Simple Elbow Dislocations Based on MRI Analysis

Common Extensor Complex Is a Predictor to Determine the Stability in Simple Posterolateral Elbow Dislocation: Analysis of MR Images of Stable vs. Unstable Dislocation

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