Elbow Dislocation with Irretrievable Rotating-Rope Injury of the Forearm: Case Report and Literature Review

Abstract

Background: Simultaneous dislocation of the elbow, radioulnar joint and proximal radius fracture with rotary noose injury to the medial ulna tubercle is extremely rare. An emergency surgery was performed to reduce it. The radial head with the backbone was reset after two hammers were fixed, then the radial capitulum safety was fixed with a locking plate. After the ulnar instability was examined, two Kirschner wires were drilled percutaneously to fix the elbow flexion at 100° under closed reduction, and two Kirschner wires were drilled percutaneously to fix the ulnar joint. Good follow-up results were achieved. To the best of our knowledge, this is the first report on this particular type of injury and on this approach to treating this type of injury.

Case presentation: We report the case of a 36-year-old male, who extended and landed on his left hand to protect his child in right arm before felling, resulting in severe pain and deformity of his left elbow and wrist and loss of movement in these joints. X-ray examination found proximal distal radioulnar joints, a proximal radial fracture and a dislocation bowstring in the ulna nodule. For a timely diagnosis in an emergency open reduction situation, accurate judgment of this injury is highly important. After 12 months of postoperative follow-up, the patient was symptom-free, and radiographs showed fracture healing.

Conclusion: We performed emergency reduction and internal fixation of the elbow and successfully saved elbow function, no stability decrease and movement restriction. This case also provides a new reference for the treatment of this type of elbow fracture dislocation.

Keywords: Cross damage; Essex-Lopresti injury; Interosseous membrane; Urotary noose upper and lower radioulnar joint.

Fig. 1

(A, B) The anteroposterior position of the elbow joint shows the position of the humeroulnar and the humeroradial relationship. The proximal end of the radius is shifted to the medial side, and the joint with the medial humericulocephalus is presented in a cross image. (C) Lateral view showing complete dislocation of the elbow with intersection of the proximal ulna and radius

Fig. 2

(A) Lateral view of the elbow after reduction showing that the ulnar joint returned to normal. (B) Anteroposterior radiographs after reduction showed recovery of the ulnar joint, asymmetry of the brachioradial joint, and displacement of the proximal radius to the medial side of the ulna

Fig. 3

(A) Three‐dimensional CT of the elbow showing dissociation and displacement of the radial head but no dissociation or displacement of the radial neck fracture. (B) Behind the elbow, the radial head rotates the noose to the ulnar tuberosity more clearly

Fig. 4

Surgical schematic diagram (A, B): Postoperative anteroposterior and lateral films. The elbow dislocation was reset, followed by the forearm rotation noose proximal ulnar radial. Two headless screws were applied to the radial fracture. To restore the humerus feet and humerus oar, gram needle percutaneous fixation was applied at 90 degrees elbow flexion. At the same time, the forearm supination ulnar radial joints underwent percutaneous fixation

Fig. 5

An ultra‐elbow and wrist plaster was used to flex the elbow by 90°, and the wrist was fixed in the supine position for 6 weeks. X‐rays were reexamined every week to monitor the fracture position. Orthopedic rehabilitation exercises were performed twice a week from 4 weeks to 6 months after the operation.(A, B). After 12 months of postoperative follow‐up, the patient was symptom‐free, and radiographs showed fracture healing