Elbow dislocations: a review ranging from soft tissue injuries to complex elbow fracture dislocations

Carsten Englert, Johannes Zellner, Michael Koller, Michael Nerlich, Andreas Lenich, Carsten Englert, Johannes Zellner, Michael Koller, Michael Nerlich, Andreas Lenich

Abstract

This review on elbow dislocations describes ligament and bone injuries as well as the typical injury mechanisms and the main classifications of elbow dislocations. Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Special emphasis is put on injuries to the medial ulnar collateral ligament (MUCL) and on posttraumatic elbow stiffness.

Figures

Figure 1
Figure 1
(a) Dorsal view to an anatomic elbow preparation. The posterior lateral ulnar collateral ligament (LUCL) and the posterior medial ulnar collateral ligament (MUCL) are visible. The posterior part of the ligamentum annulare with its insertion to the ulnar and the above lying distal part of the LCL can be seen. (b) Ventral view to an anatomic elbow preparation with demonstration of the anterior medial ulnar collateral ligament (aMUCL). The plane joint surface of the anteromedial facet of the olecranon can be seen, which has a buttress function in varus and valgus stress. (c) Lateral view to an anatomical elbow preparation with an illustration of the lateral collateral ligament complex (LCL) which is formed by the annular ring running to the radial epicondyle humeri.
Figure 2
Figure 2
(a) The combined mechanical function of MUCL, anteromedial facet of the olecranon and radial head in valgus, and external rotational stability are demonstrated. (b) The yellow spot on the anatomical preparation illustrates types I and II coronoid fractures. Type III fractures of the olecranon (green spot) involve the anterior MUCL, which result in sudden angular and translational instability of the elbow between 30° and 60°.
Figure 3
Figure 3
Examination of the elbow joint under intensifier during 0-30-60-90° of varus and valgus stresses.
Figure 4
Figure 4
Isolated rupture of the lateral ulnar collateral ligament (LUCL) resulting in persistent posterolateral rotational instability (PLRI) in a patient who works as an anesthesiologist. She was not able to retract the speculum after trauma. The picture illustrates the intraoperative reconstruction of the proximal torn LUCL.
Figure 5
Figure 5
(a) Isolated rupture of the anterior medial ulnar collateral ligament (aMUCL) by valgus stress trauma. The patient was typically suffering from a limited range of motion in flexion. Full range of motion with a stable elbow was restored with conservative treatment 10 weeks after trauma. (b) MRI proofed isolated aMUCL rupture of the photographed patient. The sagittal plane illustrated an inflammatory reaction. (c) The frontal plane demonstrated the rupture of the MUCL complex from its proximal insertion on the medial epicondyle humeri.
Figure 6
Figure 6
(a) X-rays illustrating radial head multifragmentary fracture. One slice of the CT scan proves the bony tendon tear of the triceps by a young sports student, who was suffering from an elbow dislocation. (b) Postoperative X-rays demonstrating radial head reconstruction and stabilization. The bony tear of the triceps tendon was sutured to the olecranon tip. (c) Forty-eight weeks after trauma, the young athlete was not able to straighten the left elbow. Full range of motion was restored within 6 weeks by applying oral cortisone therapy with Prednisolon 5 mg tablets in decreasing dosage as described in Table 2.

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