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 Table of Contents  
CASE REPORTS
Year : 2022  |  Volume : 37  |  Issue : 2  |  Page : 103-105

An adult with elbow dislocation with entrapped osteochondral fragment of olecranon


Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Faculty of Medicine, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Date of Submission15-May-2022
Date of Acceptance14-Sep-2022
Date of Web Publication19-Oct-2022

Correspondence Address:
Mohammad Julfiqar
Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College, Faculty of Medicine, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jbjd.jbjd_8_22

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  Abstract 

In this case report, we present a young adult presenting with a traumatic elbow dislocation with an entrapped osteochondral fragment. An initial diagnosis of traumatic elbow dislocation with entrapped medial epicondyle was made but later on it was found to be an osteochondral fragment detached from the olecranon fragment. The patient required surgical intervention to restore a congruent and stable elbow joint. This case report is novel as the elbow dislocation with osteochondral fragment entrapment is occurring in an adult; at the same time, the fragment belongs to the olecranon, and cases of which have not been reported yet.

Keywords: Dislocation, elbow, surgery, trauma


How to cite this article:
Julfiqar M, Khan AQ, Khan IR, Motiwala ZY, Singh C, Rehman Mohammad AK. An adult with elbow dislocation with entrapped osteochondral fragment of olecranon. J Bone Joint Dis 2022;37:103-5

How to cite this URL:
Julfiqar M, Khan AQ, Khan IR, Motiwala ZY, Singh C, Rehman Mohammad AK. An adult with elbow dislocation with entrapped osteochondral fragment of olecranon. J Bone Joint Dis [serial online] 2022 [cited 2022 Nov 29];37:103-5. Available from: http://www.jbjd.in/text.asp?2022/37/2/103/358803




  Introduction Top


Entrapment of the medial epicondyle within the elbow joint is seen in 5%–18% of the cases of medial humerus epicondyle fractures.[1] Traumatic elbow dislocations with entrapped bone fragments within the ulnohumeral joint are common in the pediatric age group but rare in adults. The avulsion of the medial epicondyle becomes likely as the traction of the medial collateral ligament can easily cause an avulsion of the unfused medial epicondyle as the closure of the epiphyseal line occurs after the ossification center fuses in the distal humerus.[2],[7] Traumatic elbow dislocations with fracture and ligamentous injuries can have unsatisfactory outcomes as such complex elbow instabilities are challenging to treat.[6] Entrapment of an osteochondral fragment from olecranon is an extremely unusual finding associated with traumatic elbow dislocations in adults. In this case report, we present a young adult presenting with a traumatic fracture dislocation of the left elbow with an entrapped osteochondral fragment.


  Case Report Top


An 18-year-old boy presented with an injury to his left elbow due to falling from a height. The injured elbow was painful, swollen, and deformed with severe restriction of movement. Physical examination showed swelling and tenderness on palpation of the elbow joint. Passive and active movement of the joint was restricted.

For these complaints, an X-ray of the injured elbow anteroposterior and lateral views were done. The radiographs showed elbow dislocation with entrapment of bony fragment within ulnohumeral joint space [Figure 1]A. The initial diagnosis was traumatic elbow dislocation with entrapped medial epicondyle. A trial of closed elbow reduction was done under general anesthesia. Post-reduction check X-ray of the elbow showed that the ulnohumeral joint was still incongruent due to entrapped bone fragment within the joint [Figure 1]B. Therefore, an open reduction of the elbow with the aim of fixation of the entrapped bone fragment was made.
Figure 1: (A) Radiographs showing elbow dislocation with entrapment of bony fragment within ulnohumeral joint space. (B) Post-reduction check X-rays of elbow showing that the ulnohumeral joint was still incongruent due to entrapped bone fragment within the joint

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The elbow joint was approached through a medial surgical incision. The medial collateral ligaments as well as the ulnohumeral joint capsule were torn leading to valgus instability at the elbow. To access the entrapped bony fragment, a valgus stress was applied at the elbow. When the entrapped bone fragment was retrieved, it was actually found to be an osteochondral fragment originating from the anterolateral corner of the olecranon [Figure 2]. As this fragment was not amenable to fixation, owing to its small size, it was removed. This was followed by the repair of the torn ulnohumeral joint capsule and medial collateral ligament to restore the valgus stability of the injured elbow. Postoperatively the limb was kept in an above elbow pop slab for 3 weeks [Figure 3]. Thereafter elbow ranges of motion exercises were started. At the final follow-up at 6 months, the patient had a stable and functional elbow joint with occasional mild elbow pain; for which, he did not require any analgesic medicine.
Figure 2: Intraoperatively entrapped bone fragment which was retrieved and found to be an osteochondral fragment detached from the anterolateral corner of the olecranon (tip of the artery forceps)

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Figure 3: Final postoperative anteroposterior and lateral radiographs of the left elbow of same patient showing congruent reduction of the ulnohumeral joint

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  Discussion Top


Elbow dislocations are rare in adults but common among the pediatric population as its epiphyseal line is the last ossification center to fuse in the distal humerus among the age group 15–20 years.[2] Patric[4] stated that not many adult cases are found in literature and the common age group for this injury is 10–17 years. The occurrence of avulsion of fragments from the medial or lateral epicondyle is approximately 12% and from the coronoid process is 10% of elbow dislocations.[3]

This case is peculiar because there are no existing case reports on the entrapment of anterolateral fragment of the olecranon process in the ulnohumeral joint. In a review of 143 cases of medial epicondyle fractures at a hospital in New York, Smith saw only five adults with this atypical presentation. In two cases, he found an associated fracture of the radial head but no case of olecranon osteochondral fragment entrapment.[5]

Most of the times when the patient presents with complex type of elbow dislocation, medial epicondyle fragment entrapment is anticipated. Through this case report, we want olecranon entrapment to be included in the existing differential diagnosis of elbow dislocation with entrapment of bony fragment. This will help orthopedician manage the patient and reconstruct the joint closest to the ulnohumeral joint anatomy. More literature is needed on the different strategies for the reconstruction of the avulsed olecranon that is entrapped in the elbow joint.


  Conclusion Top


Entrapment of osteochondral fragments following traumatic elbow dislocation is extremely unusual in adults. No cases of olecranon fragment entrapment in the ulnohumeral joint were found in the literature to the best of our knowledge that is available through open access journals of orthopedic surgery. This case report is novel as the elbow dislocation along with bony fragment entrapment is occurring in an adult; at the same time the fragment belongs to olecranon, and cases of which have not been reported yet. A trial of close reduction followed by open reduction with removal of fragment, restoration of ulnohumeral joint capsule, and medial collateral ligament was done. Timely management of this injury helped to prevent the development of secondary arthritis of the ulnohumeral joint as well as restore the valgus stability of the elbow joint. Careful preoperative planning, operative management, and postoperative care are imperative for satisfactory outcomes.

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

Not applicable.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tarallo L, Mugnai R, Fiacchi F, Adani R, Zambianchi F, Catani F Pediatric medial epicondyle fractures with intra-articular elbow incarceration. J Orthop Traumatol 2015;16:117-23.  Back to cited text no. 1
    
2.
Dodds SD, Flanagin BA, Bohl DD, DeLuca PA Smith BG Incarcerated medial epicondyle fracture following pediatric elbow dislocation: 11 cases. J Hand Surg 2014;39:1739-45.  Back to cited text no. 2
    
3.
O’Driscoll SW Morrey’s The Elbow and Its Disorders. 4th ed. USA: Saunders; 2008.  Back to cited text no. 3
    
4.
Patric J Fracture of the medial epicondyle with displacement into the elbow joint. J. Bone Joint Surg 1946;28:143-6.  Back to cited text no. 4
    
5.
Smith FM Medial epicondyle injuries. JAMA 1942;142:397.  Back to cited text no. 5
    
6.
Rodriguez-Martin J, Pretell-Mazzini J, Cecilia-Lopez D, Resines-Erasun C Medial complex elbow dislocation: An unusual pattern of injury. J Orthop Trauma 2010;24:e21-4.  Back to cited text no. 6
    
7.
Khan SA, Zahid M Dislocation of the elbow with intra-articular entrapment of the medial epicondyle in adults: Report of two cases. Acta Orthop Bel 2002;68:83-6.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Abstract
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Case Report
Discussion
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