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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 98-99

Anterior dislocation of the elbow with lateral condyle fracture in a child: A rare concomitant injury


Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India

Date of Submission01-May-2020
Date of Acceptance23-Jun-2020
Date of Web Publication10-Sep-2020

Correspondence Address:
Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JODP.JODP_14_20

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  Abstract 


Elbow dislocation in children is a rare injury and the anterior dislocation is a rarer variant. These may at times be associated with fractures of condyles or epicondyles of the distal humerus among others. An anterior elbow dislocation along with concomitant fracture of the displaced lateral condyle is a very rare injury, which was successfully managed and is described here with relevant details. Anterior elbow dislocation in a 7-year-old child was reduced, and the lateral condyle fracture was managed by open reduction and K-wire fixation. Good functional outcome was noted despite radiological irregularity over the capitellum with child performing all activities of daily living.

Keywords: Anterior dislocation, elbow dislocation, elbow injury, fracture, lateral condyle, pediatric


How to cite this article:
Dharmshaktu GS. Anterior dislocation of the elbow with lateral condyle fracture in a child: A rare concomitant injury. J Orthop Dis Traumatol 2020;3:98-9

How to cite this URL:
Dharmshaktu GS. Anterior dislocation of the elbow with lateral condyle fracture in a child: A rare concomitant injury. J Orthop Dis Traumatol [serial online] 2020 [cited 2020 Sep 22];3:98-9. Available from: http://www.jodt.org/text.asp?2020/3/2/98/294727




  Introduction Top


The dislocation of the elbow is an uncommon injury, and most of the dislocations are posterior in both the children and adults. The position of the radius and ulna with respect to the humerus decides the type of dislocation, and the placement of former bones anterior to the humerus makes it anterior elbow dislocation.[1] Fracture of the lateral condyle along with elbow dislocation is often reported, but most of the reported dislocations are posteromedial.[2] The anterior dislocation is rare and usually results from a direct blow to the dorsal forearm when the elbow is semiflexed. No anterior dislocation was noted in a recent large series of 48 cases of elbow dislocation; however, lateral condyle fracture was noted as the second most common associated injury following the medial epicondyle fracture in association with elbow dislocations.[3]


  Case Report Top


A 7-year-old male patient presented to us with a history of fall from tress followed by landing on his elbow. There were immediate pain, swelling, and deformity noted, and he was taken to the local center with the arm in a similar position held, with a scarf tied along the neck. Radiographs were taken there and referral was done. The elbow was flexed 20° and there was nonpalpable olecranon, whereas distal neurovascular status was intact. The radiograph of the elbow, though not with ideal lateral position due to pain and attitude of the limb, showed the placement of proximal radius and ulna anterior to the olecranon, suggesting anterior elbow dislocation [Figure 1]a. There was a presence of displaced lateral condyle fracture also noted as an associated injury. The elbow was promptly reduced under sedation in the emergency by gentle traction and downward push to proximal forearm bones to reduce it clinically. The postreduction radiographs showed well-reduced elbow joint with associated lateral condyle fracture [Figure 1]b. The displaced lateral condyle fracture was managed by surgical fixation following informed consent and fixed with two lateral K-wires by open reduction [Figure 1]c. A postoperative period was uneventful, and a plaster splint for 5 weeks was continued. The wires were removed after 6 weeks completion, and gentle physiotherapy was initiated. No clinical functional limitation was noted in the follow-up with a range of motion regained, despite radiographs showing trochlear irregularity [Figure 2]. The patient and relatives were told about prognosis and periodic review till skeletal maturity.
Figure 1: Radiograph of the elbow showing anterior placement of the radius and ulna relative to distal humerus, suggesting anterior elbow dislocation along with lateral condyle fracture (a), the postreduction radiograph showing reduced elbow with lateral condyle fracture (b). The postoperative radiograph showing fracture fixation with K-wires (c)

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Figure 2: Radiograph at follow-up showing well-aligned and stable elbow. Healed fracture with irregularity noted at the capitellar region was without any related clinical problem

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  Discussion Top


The anterior dislocations are rare and only limited to sporadic case reports or small series. In one recent study of 104 pediatric dislocations, only 2 (1.9%) of them were anterior.[4] Medial epicondyle fractures have occasionally been reported with anterior elbow dislocation but combination of lateral condyle fracture and elbow dislocation is rare.[5] In a recent large series, three out of 33 children had anterior dislocation, and one of that case of anteromedial dislocation had associated lateral condyle fracture.[6] Lateral condyle fracture, though commonly associated with simple elbow dislocations, are not commonly reported with anterior dislocation; however, one cause of their uncommon association may be rarity of anterior dislocations itself.[3],[5],[6] The concomitant injuries such as neurovascular injuries should be noted in these dislocations.[1],[7] Most dislocations are managed conservatively with good outcome, with simple dislocations faring better than those with associated fractures.[1],[4],[8] In pediatric population, anterior transolecranon fracture dislocation is also common and may or may not require fixation of olecranon fragment also.[9] In very small children, these dislocations might as well be physeal separations seen on radiographs as dislocations. Anterior transphyseal separation has also been noted in bigger children beyond the common age of physeal separation.[10]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wilkins KE. Frcartures and dislocations of elbow region. In: Rockwood CA, Wilkins KE, King RE, editors. Fractures in Children. 4th ed. Vol. 3. Philadelphia: Lippincot Raven; 1996. p. 653-887.  Back to cited text no. 1
    
2.
Silva M, Cooper SD, Cha A. Elbow dislocation with an associated lateral condyle fracture of the humerus: A rare occurrence in the pediatric population. J Pediatr Orthop 2015;35:329-33.  Back to cited text no. 2
    
3.
Kaziz H, Naouar N, Oswan W, Ayeche ML. Outcome of pediatric elbow dislocations. Mater Str J 2016;10:44-9.  Back to cited text no. 3
    
4.
Hyvönen H, Korhonen L, Hannonen J, Serlo W, Sinikumpu JJ. Recent trends in children's elbow dislocation with or without a concomitant fracture. BMC Musculoskelet Disord 2019;20:294.  Back to cited text no. 4
    
5.
Kumar R, Sekhawat V, Sankhala SS, Bijarnia I. Anterior dislocation of elbow joint-case report of a rare injury. J Orthop Case Rep 2014;4:16-8.  Back to cited text no. 5
    
6.
Rasool MN. Dislocations of the elbow in children. J Bone Joint Surg Br 2004;86:1050-8.  Back to cited text no. 6
    
7.
Kailash S, Shanmuganathan S. Anterior dislocation of elbow with neurovascular injury: A rare case report. J Orthop Case Rep 2017;7:91-4.  Back to cited text no. 7
    
8.
Kaziz H, Naouar N, Sman W, Ayeche ML. Outcome of paediatric elbow dislocations. Malays Orthop J 2016;10:44-9.  Back to cited text no. 8
    
9.
Miravete-Galvez A, Saleme-Cruz J, Jorba-Elguero P, Dabaghi-Richer A. Anterior transolecranon fracture-dislocation of the elbow in a 4-year-old child. J Musculoskelet Surg Res 2019;3:228-30.  Back to cited text no. 9
  [Full text]  
10.
Dharmshaktu GS. Anteromedial epiphyseal separation of the distal humerus in an 8-year-old girl: A case report and literature review of a rare injury pattern. Hand Microsurg 2019;8:113-7.  Back to cited text no. 10
    


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