Image Quiz
An Unusual Dislocation of the Elbow1
A moderately obese thirty-five-year-old woman sustained multiple upper extremity fractures after falling off a porch from a height of approximately four feet. She was initially evaluated at a local emergency room where physical examination and radiographs revealed a posterior elbow dislocation of the left, nondominant arm (Figs. 1-A and 1-B), an ipsilateral displaced and comminuted intra-articular distal radial fracture, and a displaced fracture of the base of the contralateral thumb metacarpal. She was subsequently transferred to our facility for definitive treatment.
The patient had pain in the left wrist and elbow, with a limited range of motion, and pain in the right thumb. She had an obvious dorsal deformity of the distal part of the radius in the left arm with minimal swelling. The left elbow was held at approximately 80° of flexion, and she had a painful and limited range of motion. The right thumb was tender to palpation at the base of the metacarpal with no obvious deformity. The neurovascular examination revealed normal findings. An initial review of the radiographs revealed an obvious posterior dislocation of the elbow (Figs. 1-A and 1-B).
Fig. 1-A |
Fig. 1-B |
Figs. 1-A and 1-B The initial radiographs demonstrating posterior dislocation of the left elbow. Fig. 1-A Lateral radiograph. Fig. 1-B Anteroposterior radiograph.
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The patient was managed with intravenous conscious sedation in the emergency department, and a closed reduction of the ulnohumeral joint was performed. The extremity was placed in a long arm posterior splint. Radiographs made after the reduction showed persistent translocation of the radius and ulna (Figs. 2-A and 2-B).
Fig. 2-A |
Fig. 2-B |
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