Current concepts in diagnosis, classification, and treatment of acute complex elbow dislocation: a review

Abstract

Complex elbow dislocations involve periarticular fractures in addition to capsuloligamentous disruption. These dislocations can result from a simple fall on an outstretched hand or from high-energy trauma, and the pattern of injury is affected by the direction of the force causing the injury. Fracture patterns in complex elbow dislocations vary based on whether the injury is posterolateral, anterior, posteromedial, or medial. The primary goals of care in treating complex elbow dislocations include restoring anatomical alignment of the ulnohumeral and radiocapitellar joints, providing stability, and facilitating early motion after definitive treatment. Depending on fracture pattern and joint stability, definitive treatment can be nonoperative with closed reduction and bracing or operative with capsuloligamentous repair, open reduction and internal fixation of fractures, arthroplasty, or application of an external fixator. Common complications include neurovascular injury, chronic instability, posttraumatic arthritis, compartment syndrome, stiffness, and heterotopic ossification. Understanding how best to treat each type of complex elbow dislocation is essential to optimizing long-term elbow mobility and function while avoiding potential complications.

Posterior Olecranon Fracture Dislocations in Adults: A Systematic Review

“…The treatment goals of complex elbow fracture dislocations include the restoring anatomical alignment of the joint, providing stability, and facilitating early motion 1–3 . As described above, the main issues in POFDs would be the disruption of the trochlear notch and the radial head fractures.…”

“…The majority of authors considered POFDs as a posterior Monteggia lesions possibly because the stability of the ulnahumeral joint had already been compromised by the fracture of olecranon and coronoid process, and it was common to see the dislocation of the ulnahumeral joint in type IIA and IID posterior Monteggia lesions 11,23 . However, Monteggai lesions are so broad that they include injuries from the elbow joint to the forearm, which makes it less specific 1–3 . Moreover, the Monteggai lesions emphasize the disruption of the PRUJ, which represents the injury of the forearm 1 .…”

“…However, in OFDs, the posterior olecranon fracture dislocations (POFDs) were usually considered as posterior Monteggia lesions, and unlike the other complex elbow fracture dislocations, the POFDs were less described in the literature. 1,3,6,7 There is no consensus on POFDs. The description of POFDs is scattered in posterior Monteggia lesions, complex elbow fracture dislocations and OFDs.…”

“…Multiple injuries to these structures will lead to a complex elbow dislocation. There exist several common patterns: the terrible triad, posteromedial fracture dislocation, olecranon fracture dislocations (OFDs), posterior fracture elbow dislocation with intact proximal radioulnar joint (PRUJ) and Monteggia fracture dislocations 3–5 . Recognition of the pattern of an elbow fracture‐dislocation allows immediate knowledge of the treatment principles, pitfalls, and prognosis of the injury.…”

“…Recognition of the pattern of an elbow fracture‐dislocation allows immediate knowledge of the treatment principles, pitfalls, and prognosis of the injury. However, in OFDs, the posterior olecranon fracture dislocations (POFDs) were usually considered as posterior Monteggia lesions, and unlike the other complex elbow fracture dislocations, the POFDs were less described in the literature 1,3,6,7 …”