Skip to main content
SpringerLink
Log in

Acute elbow dislocation: comparison between magnetic resonance imaging and intra-operative finding of ligament injury

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this current study was to assess elbow ligament tears after dislocation using magnetic resonance imaging (MRI) and to correlate any pre-operative imaging with intra-operative findings of elbow ligament tears.

Methods

We prospectively included 32 patients with acute elbow dislocation investigated by MRI at a means of five days from dislocation. A simple elbow dislocation was diagnosed in 14 patients (44%); associated bone injuries were identified in 18 elbows (56%). Surgical repair of elbow ligaments was carried out in 23 patients, and nine cases were treated non-operatively. A blinded MRI evaluation of all 32 elbows was performed by an orthopaedic surgeon (rater 1) and a musculoskeletal radiologist (rater 2).

Results

Inter-rater agreement for MRI evaluation of 32 was poor for lateral ulnar collateral ligament (LUCL) tears, fair for radial collateral ligament (RCL), moderate for annular ligament (AL), and fair for ulnar collateral ligament (UCL). All tears were reported as complete by rater 1; 13/32 partial tears were identified by rater 2 (LUCL = 2, RCL = 2, UCL = 9). Correlation between surgical and MRI findings showed good inter-rater agreement for LUCL and AL tears in both raters. Agreement for RCL tear was poor for rater 1 and fair for rater 2; agreement for UCL tear was fair for rater 1 and poor for rater 2. Intra-operative findings showed ten radial head fractures (RHFs) and ten coronoid fractures (CFs). LUCL tears were found in the four cases of type II RHFs and in 3/4 cases of CFs. Bone injuries and ligament tears were not significantly associated.

Conclusion

MRI scan supported surgeons to identify soft tissue injuries and to address the most suitable surgical approach after acute elbow dislocation. Inter-observer agreement for intra-operative findings was high for LCL complex injuries and poor for UCL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Stoneback JW, Owens BD, Sykes J et al (2012) Incidence of elbow dislocations in the United States population. J Bone Joint Surg Am 94:240–245. https://doi.org/10.2106/JBJS.J.01663

    Article  PubMed  Google Scholar 

  2. De Haan J, Schep NW, Tuinebreijer WE et al (2010) Simple elbow dislocations: a systematic review of the literature. Arch Orthop Trauma Surg 130:241–249. https://doi.org/10.1007/s00402-009-0866-0

    Article  PubMed  Google Scholar 

  3. Camp CL, Fu M, Jahandar H, et al. (2019) The lateral collateral ligament complex of the elbow: quantitative anatomic analysis of the lateral ulnar collateral, radial collateral, and annular ligaments. J Shoulder Elbow Surg; 28: 665–670 2018/12/12. https://doi.org/10.1016/j.jse.2018.09.019

  4. Cinque ME, Schickendantz M, Frangiamore S (2020) Review of anatomy of the medial ulnar collateral ligament complex of the elbow. Curr Rev Musculoskelet Med. https://doi.org/10.1007/s12178-020-09609-z

  5. Morrey BF, An KN (1985) Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res:84–90

  6. O'Driscoll SW, Bell DF, Morrey BF (1991) Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 73:440–446

    CAS  PubMed  Google Scholar 

  7. Rhyou IH, Lee JH, Lee JH et al (2020) Soft tissue injury patterns in posteromedial rotatory instability with dislocation compared with posteromedial dislocation of the elbow joint. J Shoulder Elb Surg. https://doi.org/10.1016/j.jse.2019.11.002

  8. Dewan AK, Chhabra AB, Khanna AJ et al (2013) MRI of the elbow: techniques and spectrum of disease: AAOS exhibit selection. J Bone Joint Surg Am 95(e99):91–13. https://doi.org/10.2106/JBJS.L.01621

    Article  Google Scholar 

  9. Lee SH, Nam DJ, Yu HK et al (2020) The lateral ligament is injured preferentially in posterolateral dislocation of the elbow joint. Bone Joint J 102-B:227–231. https://doi.org/10.1302/0301-620X.102B2.BJJ-2019-0966.R1

    Article  PubMed  Google Scholar 

  10. Luokkala T, Temperley D, Basu S et al (2019) Analysis of magnetic resonance imaging-confirmed soft tissue injury pattern in simple elbow dislocations. J Shoulder Elb Surg 28:341–348. https://doi.org/10.1016/j.jse.2018.08.010

    Article  Google Scholar 

  11. Cho CH, Kim BS, Rhyou IH et al (2018) Posteromedial elbow dislocations without relevant osseous lesions: clinical characteristics, soft-tissue injury patterns, treatments, and outcomes. J Bone Joint Surg Am 100:2066–2072. https://doi.org/10.2106/JBJS.18.00051

    Article  PubMed  Google Scholar 

  12. Lee JH, Lee JH, Kim KC et al (2019) Treatment of posteromedial and posterolateral dislocation of the acute unstable elbow joint: a strategic approach. J Shoulder Elb Surg 28:2007–2016. https://doi.org/10.1016/j.jse.2019.05.029

    Article  Google Scholar 

  13. Schreiber JJ, Potter HG, Warren RF et al (2014) Magnetic resonance imaging findings in acute elbow dislocation: insight into mechanism. J Hand Surg Am 39:199–205. https://doi.org/10.1016/j.jhsa.2013.11.031

    Article  PubMed  Google Scholar 

  14. Rhyou IH, Kim YS (2012) New mechanism of the posterior elbow dislocation. Knee Surg Sports Traumatol Arthrosc 20:2535–2541. https://doi.org/10.1007/s00167-011-1872-7

    Article  PubMed  Google Scholar 

  15. Broberg MA, Morrey BF (1987) Results of treatment of fracture-dislocations of the elbow. Clin Orthop Relat Res:109–119

  16. Regan W, Morrey B (1989) Fractures of the coronoid process of the ulna. J Bone Joint Surg Am 71:1348–1354

    CAS  PubMed  Google Scholar 

  17. Binaghi DMR (2015) Imaging of the elbow. Magn Reson Imaging Clin N Am 23:427–440. https://doi.org/10.1016/j.mric.2015.04.005

    Article  PubMed  Google Scholar 

  18. Bucknor MD, Stevens KJ, Steinbach LS (2016) Elbow imaging in sport: sports imaging series. Radiology 280:328. https://doi.org/10.1148/radiol.2016164015

    Article  PubMed  Google Scholar 

  19. Schaeffeler C, Waldt S, Woertler K (2013) Traumatic instability of the elbow - anatomy, pathomechanisms and presentation on imaging. Eur Radiol 23:2582–2593. https://doi.org/10.1007/s00330-013-2855-5

    Article  PubMed  Google Scholar 

  20. Mak S, Beltran LS, Bencardino J et al (2014) MRI of the annular ligament of the elbow: review of anatomic considerations and pathologic findings in patients with posterolateral elbow instability. AJR Am J Roentgenol 203:1272–1279. https://doi.org/10.2214/AJR.13.12263

    Article  PubMed  Google Scholar 

  21. Tarallo L, Porcellini G, Merolla G et al (2020) Isolated displaced type II partial articular radial head fracture: correlation of preoperative imaging with intraoperative findings of lateral ulnar collateral ligament tear. J Shoulder Elb Surg 29:132–138. https://doi.org/10.1016/j.jse.2019.07.006

    Article  Google Scholar 

  22. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    CAS  Google Scholar 

  23. Schnetzke M, Schuler S, Hoffend J et al (2017) Interobserver and intraobserver agreement of ligamentous injuries on conventional MRI after simple elbow dislocation. BMC Musculoskelet Disord 18:85. https://doi.org/10.1186/s12891-017-1451-2

    Article  PubMed  PubMed Central  Google Scholar 

  24. Heo YM, Yi JW, Lee JB et al (2015) Unstable simple elbow dislocation treated with the repair of lateral collateral ligament complex. Clin Orthop Surg 7:241–247. https://doi.org/10.4055/cios.2015.7.2.241

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kim JW, Yi Y, Kim TK et al (2016) Arthroscopic lateral collateral ligament repair. J Bone Joint Surg Am 98:1268–1276. https://doi.org/10.2106/JBJS.15.00811

    Article  PubMed  Google Scholar 

  26. Schnetzke M, Aytac S, Keil H et al (2017) Unstable simple elbow dislocations: medium-term results after non-surgical and surgical treatment. Knee Surg Sports Traumatol Arthrosc 25:2271–2279. https://doi.org/10.1007/s00167-016-4100-7

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic and Traumatology, University of Modena and Reggio Emilia, Modena, Italy

    Luigi Tarallo, Giuseppe Porcellini, Gianmario Micheloni, Michele Novi, Ettore Di Giovine & Fabio Catani

  2. Shoulder and Elbow Unit, Cervesi Hospital, Cattolica, AUSL della Romagna, Via L. v. Beethoven 46, 47841, Cattolica, Italy

    Giovanni Merolla

  3. International Doctorate School (PhD) in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy

    Giovanni Merolla

  4. Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy

    Maria Grazia Amorico

Authors
  1. Luigi Tarallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giovanni Merolla
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giuseppe Porcellini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Grazia Amorico
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gianmario Micheloni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michele Novi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ettore Di Giovine
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Fabio Catani
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giovanni Merolla.

Ethics declarations

IRB approval was obtained from the institutional review board (Prot. AOU0025970/19, Comitato Etico Area Vasta Emilia Nord, Modena, Italy).

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(PDF 222 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tarallo, L., Merolla, G., Porcellini, G. et al. Acute elbow dislocation: comparison between magnetic resonance imaging and intra-operative finding of ligament injury. International Orthopaedics (SICOT) 45, 265–273 (2021). https://doi.org/10.1007/s00264-020-04875-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-020-04875-5

Keywords

Search

Navigation