Pediatric open elbow dislocation without fracture: A case report

Abstract

INTRODUCTIONElbow dislocations in children are rare injuries. These injuries are often in the form of complex injuries that is accompanied by the median nerve damage and medial epicondyle fracture in the pediatric age group. Open elbow dislocation without fracture in the pediatric age group has been reported very rarely in the literature.PRESENTATION OF CASEThe purpose of this study is to present an 8-year-old patient who has open elbow dislocation without fracture accompanying with brachial artery injury. In the clinical examination of the patient, there was an open wound in the transverse antecubital region. After repair of brachial artery injury, open reduction was performed under general anesthesia. In the postoperative clinical examination at 6 months, left elbow flexion was 140°, extension was full and there were no deficit in the supination and pronation of the forearm.DISCUSSIONElbow dislocation without fracture in pediatric patients is a very rare injury. Usually the trauma mechanism of elbow dislocation is falling on outstretched hand with elbow in approximately 30° of flexion. However our patient had fallen on outstretched hand with elbow in full extension. Although this type of trauma mechanism is typical for supracondylar humerus fractures in pediatric age group, in our patient an open posterior elbow dislocation without fracture had occurred.CONCLUSIONPediatric elbow dislocations are rare injuries and the management of these injuries can be technically demanding due to concurrent neurovascular injuries. An open dislocation without fracture is very rare and it should be treated with immediate intervention, an effective teamwork and good rehabilitation.

Early Outcomes of Pediatric Elbow Dislocation—Risk Factors Associated With Morbidity

“…Although we did not have any cases of open dislocations or vascular injuries, these have been reported in pediatric elbow dislocations. 19,20 Complications are not rare following pediatric elbow dislocations. In our series, 16/145 (11%) cases sustained a complication, and elbows without a complication were significantly more likely to have an excellent functional outcome.…”

Pure elbow dislocation in the paediatric age group

“…Dislocations of the elbow have been reported as often accompanied by disruption of multiple stabilisers, and thus the patho-physiology is complicated [15]. Traumatic elbow dislocation is uncommon in skeletally immature patients and generally diagnosed with concomitant fractures, avulsions or neurovascular injuries around the joint [1,5,6,[12][13][14][15][16][17][18][19]. Acute traumatic pure elbow dislocation in childhood is even more uncommon.…”

“…Most commonly, the type of trauma leading to dislocation is a fall on an outstretched hand with the elbow in approximately 30°of flexion or full extension [5]. Dislocations may occur in posterior, anterior, medial or lateral directions.…”

“…Instability, which may be subtle and difficult to diagnose, can occur in various directions, depending on the injured stabiliser [6]. These injuries are often in the form of complex injuries that may be associated with fractures or avulsions, as well as the neurovascular damage around the joint [5]. Medial epicondyle avulsion has been reported as the most commonly encountered concomitant injury [1,3,7].…”

Recent trends in children's elbow dislocation with or without a concomitant fracture

“…The posterior direction is the most common [3]. The trauma mechanism leading to elbow dislocation is usually similar to that of elbow fractures: a fall on an outstretched hand [4]. Dislocation is often accompanied by bone fracture, while avulsion of the medial epicondyle is the most common concomitant injury [1].…”