Traumatic divergent dislocation of the elbow in the adults

Abstract

Purpose: This retrospective study aimed to investigate the clinical outcomes of DDE in adults.

Methods: From September 2010 to March 2020, adult patients with traumatic DDEs admitted to Beijing Chaoyang Hospital and Beijing Jishuitan Hospital were included in this study. Each patient underwent operative or conservative treatment during hospitalization. The clinical and radiological examinations were followed up. The primary outcomes included the Mayo Modified Wrist Score (MMWS), the Mayo Elbow Performance Score (MEPS), the Broberg and Morrey functional index, the Disabilities of the Arm, Shoulder and Hand (DASH) score, and the Visual Analogue Scale (VAS) score that were performed. Post-operative complications and secondary surgery details were also collected.

Results: Of the fourteen patients, clinical and radiographic results were reviewed at a mean of 53.2 months (18 to 110 months) postoperatively. There were 11 men and three women with an average age of 31.5 years (17 to 51 years). At the final follow-up, the average MMWS, MEPS, Broberg and Morrey functional index, and DASH scores were 91.4 points, 93.4 points, 92.6 points, and 10.7 points. The mean VAS at rest and during activities was 0.4 and 1.7 points. Two patients required a secondary procedure due to radial malalignment and elbow contracture, respectively. In addition, two patients were found degeneration.

Conclusions: Within the context of high-energy DDE combined with simultaneous upper limb injuries, our study recommended obtaining the mechanical benefit of the forearm ring with concentric elbow stability. Despite the various and complicated traumatic patterns of DDE, great clinical results could be acquired based on adequate surgical treatments and early rehabilitation training.

Keywords: Divergent dislocation of the elbow; Fracture-dislocation of the forearm; The adults, DASH, Multiple injuries; Trauma.

Fig. 1

Anteroposterior and lateral X-ray radiographs show an isolated divergent dislocation of the elbow (a–b)

Fig. 2

Pre-operative radiographs show a divergent dislocation of the elbow (a–b) combined with a distal radius fracture (c–d)

Fig. 3

A case of a 35-year-old right-hand dominant male sustained a DDE combined with an ulnar coronoid process fracture (a–b). The patient was treated with an external fixator and a repair of the elbow joint ligament. The relatively tiny fracture fragments were not specifically addressed (c–e). Worth mentioning was the full range of motion was obtained at 12 monthly post-operative (f–i)

Fig. 4

A 20-year-old male suffering a DDE and ulnar coronoid process fracture. Closed reduction was performed immediately (a–b). However, post-operative radiographs presented the ulnar coronoid process fracture was visibly large and lodged in the elbow joint (c–f). In addition, ORIF of the ulnar coronoid process and a repair of the LCL were also applied (g–h)

Fig. 5

Radiographs of a 44-year-old right-hand dominant male exhibiting a DDE and a radial shaft fracture (a–c). Post-operative radiographs of the elbow showed good reduction and fixation with an external fixator and an ORIF of the radial shaft (d–e). The external fixator was removed at 6 weeks post-operative (f–g) and he has full range of motion at 18 monthly follow-up (h–k)

Fig. 6

Anteroposterior and lateral radiographs revealed a DDE combined with distal ulna fracture, distal radius fracture and dislocation of DRUJ (a–b). Radiographic and clinical evidence demonstrated maintenance of the reduction of the PRUJ and DRUJ (c–h)

Fig. 7

Initial radiographs of the elbow and wrist showed the DDE and a multiple fracture (a–d). All fractures were reduced by internal fixation and subsequent X-ray revealed a grade 1 heterotopic ossification at a 12 monthly follow-up (arrow) (e–h)

Fig. 8

Post-operative radiographs of the right elbow revealed a DDE and a multiple fracture (a–d). However, this patient sustained an elbow malrotation (arrow and circle), which failed to restore the anatomical radial bow (e–f). Eight weeks later, a secondary operation consisting of radius shortening and release of an elbow contracture was required to restore motion (g–j)

Fig. 9

a–b One case suffering a DDE combined with a radial shaft fracture: he received surgical treatment immediately and was found asymptomatic grade 1 heterotopic ossification (c–d). Clinical photos of the elbow 2 years after surgery showed an excellent clinical outcome compared with the opposite side after a regular rehabilitation training (e–j)