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ABSTRACT
Purpose. To evaluate results of open reduction for latepresenting (more than 3 weeks) posterior dislocation
of the elbow in 10 patients.
Method. Elbow stiffness was the main indication for
surgery. The mean age of the patients was 34 (range,
1365) years; the mean time since injury was 4 (range,
26) months. All patients had non-functional elbow
movement for any activity of daily living. Three
patients had associated fractures around the elbow
joint.
Results. At a mean follow-up of 19 (range, 1128)
months, 8 patients regained a functional range of
movement for activities of daily living and maintained a median arc of flexion of 100 degrees and a
supination-pronation arc of 140 degrees. According to
the Mayo Elbow Performance Index, the results of 5
patients were excellent, 3 were good, and 2 were poor.
Complications included pin site infection (n=2), ulnar
neuritis (n=1), and delayed wound healing (n=1).
INTRODUCTION
Late-presenting, unreduced posterior dislocation of
the elbow is a challenge for surgeons. Due to misconceptions and ignorance, many patients go to local
bonesetters for traditional treatment such as massage and manipulation, which only aggravates the
problem. Unreduced is defined as those posterior
elbow dislocations not treated within 3 weeks of
injury.13 These elbows are fixed in either extension or
flexion with only a few degrees of flexion, supination,
and pronation, and have a non-functional range of
movement for activities of daily living.2,4
The time since injury and patient age determine
the mode of treatment.3,5 Most authorities recommend
Address correspondence and reprint requests to: Dr Sameer Mehta, Registrar, 35-C, Pocket A, Phase 3, Ashok Vihar, Delhi,
110052, India. E-mail: smr_mehta@yahoo.co.in
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S Mehta et al.
Table
Patient characteristics and outcomes
Patient No.
1
2
3
4
5
6
7
8
9
10
Sex/age
(years)
Injured side
Mode of injury
Duration of dislocation
(months)
M/40
M/13
M/35
M/45
F/16
M/25
M/20
F/65
F/42
M/42
L
R
L
R
L
R
R
L
L
R
Fall
Fall
Fall
Fall
Traffic accident
Fall
Traffic accident
Fall
Fall
Fall
6
4
4
4
2
4
5
2
6
2.5
Associated fracture
Medial condyle
Ulnar shaft and radial head
Radial head
Range of movement
Before reduction
At follow-up
Flexion
Pronation/supination
Flexion
Pronation/supination
10 (1020)
40 (1050)
Fixed in 20 of flexion
40 (040)
10 (1020)
10 (1020)
30 (2050)
30 (2050)
20 (1535)
15 (1530)
35 (2015)
60 (3030)
20 (200)
45 (2025)
70 (4530)
60 (3030)
60 (4020)
40 (3010)
20 (1010)
75 (4530)
90 (10100)
110 (20130)
80 (20100)
45 (1055)
110 (10120)
45 (80125)
100 (20120)
130 (20140)
105 (15120)
100 (15115)
130 (7060)
170 (10070)
150 (10050)
100 (5050)
130 (7050)
170 (8090)
150 (9060)
170 (5050)
130 (7060)
145 (5095)
17
Mayo Elbow
Performance
Index10
Follow-up
(months)
80
100
75
40
80
40
95
100
100
90
18
12
14
24
12
18
24
11
28
24
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S Mehta et al.
(a)
(d)
(b)
(e)
(c)
(f)
Figure 2 Patient 2: a 13-year-old boy with 4-month-old unreduced posterior dislocation of the left elbow: (a) clinical
presentation, (b) lateral radiograph showing posterior dislocation of the olecranon and myositis ossificans on the posterior aspect
of the lower humerus. (c) Postoperative radiograph showing fixation of the olecranon to distal humerus using Kirschner wires.
(d), (e), and (f) At 12-month follow-up, the patient has useful functional range of movement of the left elbow for activities of daily
living.
(a)
(b)
(d)
19
(c)
(e)
Figure 3 Patient 9: a 42-year-old woman with 6-month-old unreduced posterior dislocation of the left elbow: (a) the
elbow has fixed flexion deformity of 15 and range of flexion of 20. (b) Lateral and (c) anteroposterior radiographs showing
posterior and medial dislocation of the olecranon. (d) Postoperative radiographs showing fixation of the radius and ulna with
Kirschner wires to the distal part of the humerus. (e) At 28-month follow-up, the patient has functional range of elbow flexion
of 105.
radiocapitellar alignment. Three patients had evidence of mild joint space narrowing and osteophyte
formation (grade 1 arthrosis), one had severe (grade
3) changes with a loss of joint space, and one had
severe degenerative changes with myositis ossificans
on the anterior aspect of the elbow.
Complications included: pin site infections (n=2),
treated by oral antibiotics and dressings; a gaping
wound on removal of stitches (n=1), treated by daily
dressings and a secondary intervention within 10
days; and joint swelling with mild tenderness (n=2)
at one year.
DISCUSSION
Most cases of old unreduced dislocations of the elbow
are found in rural areas of this country, where qualified
doctors are lacking and traditional bonesetters easily
available. Such patients are often neglected and
maltreated before being seen by a specialist in a city
hospital.
Most of these dislocations are caused by a fall on
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S Mehta et al.
21
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