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The three-column concept of elbow joint stability and the Wrightington elbow fracture-dislocation classification, emphasizing the role of cross-sectional imaging

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Abstract

Elbow fracture-dislocation is a complex injury with a combination of osseous and soft tissue disruption. Different classification systems have been used to describe the injury pattern and help guide the management. The article describes the important cross-sectional findings in complex elbow fracture-dislocation injuries based on the relatively new Wrightington classification. This includes the various elements and patterns seen in elbow fracture-dislocations providing a simple and comprehensive system to classify these injuries and help guide the surgical management. The article also describes the three-column concept of elbow joint stability, dividing the elbow joint osseous structures into lateral, middle and medial columns. Detailed radiological assessment of the fractures pattern is vital to understand the mechanism of injury, allowing clinicians to predict the associated capsuloligamentous injury and help guide the management decisions. The Wrightington elbow fracture-dislocation classification categorizes the injuries according to the ulnar coronoid process and radial head fractures. Type A is an anteromedial coronoid fracture. Type B is a bifacet or basal coronoid fracture, with B + indicating associated radial head fracture. Type C is a combined anterolateral facet and radial head or comminuted radial head fractures. Type D is a diaphyseal ulnar fracture, with D + indicating associated radial head fracture.

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Authors and Affiliations

  1. Radiology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, Royal Albert Edward Infirmary, Wigan Lane, Wigan, WN1 2NN, UK

    Zeid Al-Ani

  2. Upper Limb Unit, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK

    Andrew Wright, Matthew Ricks & Adam C. Watts

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Contributions

Zeid Al-Ani contributed to the idea and design of this review, drafting the article and revising it critically. He is in approval of the version submitted and agrees to be accountable for all aspects of the work if questions arise related to its accuracy or integrity. Andrew Wright contributed to the idea and design of this review, drafting the article and revising it critically. He is in approval of the version submitted and agrees to be accountable for all aspects of the work if questions arise related to its accuracy or integrity. Matthew Ricks contributed to the idea and design of this review, drafting the article and revising it critically. He is in approval of the version submitted and agrees to be accountable for all aspects of the work if questions arise related to its accuracy or integrity. Adam C Watts contributed to the idea and design of this review, drafting the article and revising it critically. He is in approval of the version submitted and agrees to be accountable for all aspects of the work if questions arise related to its accuracy or integrity.

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Correspondence to Zeid Al-Ani.

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Al-Ani, Z., Wright, A., Ricks, M. et al. The three-column concept of elbow joint stability and the Wrightington elbow fracture-dislocation classification, emphasizing the role of cross-sectional imaging. Emerg Radiol 29, 133–145 (2022). https://doi.org/10.1007/s10140-021-01978-3

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