Anterior elbow fracture dislocation with ulnar nerve palsy in a six-year-old child
- Authors: Ashar N.1,2,3, Liew S.1, Azmi N.2, Yeak R.1, Lingam R.2, Chen R.2
-
Affiliations:
- Universiti Putra Malaysia
- Hospital Serdang
- Universiti Teknologi MARA (UiTM), Jalan Hospital
- Issue: Vol 8, No 2 (2020)
- Pages: 207-212
- Section: Clinical cases
- URL: https://journal-vniispk.ru/turner/article/view/17721
- DOI: https://doi.org/10.17816/PTORS17721
- ID: 17721
Cite item
Abstract
Background. Anterior elbow fracture dislocation is rare, especially in paediatric age group. Of the reported cases to date, three-quarter were posterior dislocation of the elbow. Anterior elbow dislocation is rarely reported, with incidence of only <2%.
Clinical case. A 6-year-old girl presented to casualty with left elbow deformity and pain after she tripped and fell in the toilet. Ulnar clawing was present with reduced sensation over ulnar nerve distribution. No wound was found, distal pulses and circulation were good. The X-rays showed anterior dislocation of the left elbow with olecranon fracture. Closed manual reduction was attempted but failed. Open reduction and percutaneous K-wire insertion under general anaesthesia was performed. Medial approach of the elbow was done. Intra-operatively ulnar nerve was found impinged by the distal ulnar fragment but was in continuity. The transverse olecranon fracture was fixed with two K-wires and the radial head was reduced. Ulnar nerve was mobilised until tension-free. Ulnar collateral ligament was repaired. The elbow was immobilised with a splint. Ulnar claw was resolved at 2 weeks. The fracture heals and the K-wires were removed at 6 weeks. At 8 weeks, range of movement of the elbow was full. The elbow was stable in varus and valgus.
Discussion. Anterior elbow dislocation is a high energy trauma and one should be cautious of neurovascular injury. There was no clear recommendation in the literature regarding surgical approach. We chose medial approach of the elbow for ulnar nerve exploration and olecranon fixation.
Conclusion. This rare injury should be treated with high index of suspicious. Surgical approach should be tailored individually according to the instability of the elbow joint and neurovascular status, as in this case was the posteromedial instability associated with ulnar nerve palsy.
Keywords
Full Text
##article.viewOnOriginalSite##About the authors
Nur Ayuni Khirul Ashar
Universiti Putra Malaysia; Hospital Serdang; Universiti Teknologi MARA (UiTM), Jalan Hospital
Email: ayuni.kashar@gmail.com
ORCID iD: 0000-0003-3556-0721
D-r, MBBS (UiTM), Postgraduate student & Medical Officer of the Department of Orthopaedic, Faculty of Medicine and Health Sciences
Malaysia, Serdang, Selangor; Jalan Puchong, Kajang, Selangor; Sungai Buloh, SelangorSiew Khei Liew
Universiti Putra Malaysia
Author for correspondence.
Email: kheils@upm.edu.my
ORCID iD: 0000-0003-4419-1382
D-r, MBBS (UM), MS ORTH (UM), Orthopaedic Surgeon, Hand and Reconstructive Microsurgery Unit of the Department of Orthopaedic, Faculty of Medicine and Health Sciences
Malaysia, Serdang, SelangorNur Syahirah Azmi
Hospital Serdang
Email: syahirahazmi90@gmail.com
ORCID iD: 0000-0002-4057-3749
D-r, MB BCh (Mansoura University), Medical Officer of the Department of Orthopaedic
Malaysia, Jalan Puchong, Kajang, SelangorRaymond Dieu Kiat Yeak
Universiti Putra Malaysia
Email: rayyeak@yahoo.com
ORCID iD: 0000-0001-8232-5359
D-r, MB BCh BAO (PMC), MS ORTH (UM), Orthopaedic Surgeon, Sports Surgery Unit of the Department of Orthopaedic, Faculty of Medicine and Health Sciences
Malaysia, Serdang, SelangorRahul Lingam
Hospital Serdang
Email: silverseraph15@yahoo.com
ORCID iD: 0000-0002-0546-3077
D-r, MD (KSMU), Doctor of Medicine, Medical Officer of the Department of Orthopaedic
Malaysia, Jalan Puchong, Kajang, SelangorRaimi Adam Chen
Hospital Serdang
Email: hadoken86@gmail.com
Scopus Author ID: 0000-0003-0362-521X
D-r, MD (RSMU), Doctor of Medicine, Medical Officer of the Department of Orthopaedic
Malaysia, Jalan Puchong, Kajang, SelangorReferences
- Wilkins KE. Fractures and dislocations of the elbow region. In: Fractures in children. 4th ed. Vol. 3. Ed. by C.A. Rockwood, K.E. Wilkins, R.E. King. Philadelphia: Lippincott-Raven; 1996. P. 653-887.
- Dharmshaktu G, Singhal A, Khan I. Elbow dislocation in a 3 year old child: a report of a rare injury. Int J Contemp Pediatrics. 2015:254-256. https://doi.org/10.18203/2349-3291.ijcp20150539.
- Linscheid RL. Elbow Dislocations. JAMA. 1965;194(11):1171. https://doi.org/10.1001/jama.1965. 03090240005001.
- Josefsson PO, Nilsson BE. Incidence of elbow dislocation. Acta Orthop Scand. 2009;57(6):537-538. https://doi.org/10.3109/17453678609014788.
- Neviaser JS, Wickstrom JK. Dislocation of the elbow: a retrospective study of 115 patients. South Med J. 1977;70(2):172-173. https://doi.org/10.1097/00007611-197702000-00013.
- Roberts PH. Dislocation of the elbow. Br J Surg. 1969;56(11):806-815. https://doi.org/10.1002/bjs. 1800561103.
- Kaziz H, Naouar N, Osman W, Ayeche M. Outcomes of paediatric elbow dislocations. Malays Orthop J. 2016;10(1):44-49. https://doi.org/10.5704/MOJ.1603.008.
- Pokharel B, Gyawali GP, Pokharel R. Irreducible anterior dislocation of the elbow without associated fracture. J Nepal Med Assoc. 2013;52(190). https://doi.org/10.31729/jnma.2120.
- Aroojis A, Narula V, Sanghvi D. Pure medial elbow dislocation without concomitant fracture in a 10-year-old child. Indian J Orthop. 2018;52(6):678-681. https://doi.org/10.4103/ortho.IJOrtho_534_17.
- Kumar R, Sekhawat V, Sankhala SS, Bijarnia I. Anterior dislocation of elbow joint-case report of a rare injury. J Orthop Case Rep. 2014;4(3):16-18. https://doi.org/10.13107/jocr.2250-0685.186.
- Kailash S, Shanmuganathan S. Anterior dislocation of elbow with neurovascular injury: a rare case report. J Orthop Case Rep. 2017;7(1):91-94. https://doi.org/10.13107/jocr.2250-0685.704.
- Hyvonen H, Korhonen L, Hannonen J, et al. Recent trends in children’s elbow dislocation with or without a concomitant fracture. BMC Musculoskelet Disord. 2019;20(1):294. https://doi.org/10.1186/s12891-019-2651-8.
Supplementary files
