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New mechanism of the posterior elbow dislocation

  • Elbow
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To suggest a new model on the most common kind of posterior elbow dislocation using MRI findings on acute elbow injuries.

Methods

Fifteen patients with simple elbow dislocation (Group A) and 19 patients sustaining pure ligament injuries (Group B) were enrolled in this study. Using MRI scans, bony contusion at radial head and posterior capitellum (lateral bone contusion) and medial aspect of the ulnohumeral joint (medial bone contusion) were investigated with the injury patterns of the collateral ligament and overlying muscles. In Group A, the injury patterns of the ulnar and lateral ulnar collateral ligaments were classified into distraction or stripping type; in Group B, into rupture or strain. Based on these findings, we speculated the injury mechanism of the elbow dislocation.

Results

In Group A, posterolateral (PL) dislocation was found in 12 cases of distractive ulnar collateral ligament type and stripping lateral ulnar collateral ligament type, where lateral bone contusion was found in 11 cases. Posteromedial (PM) dislocation was observed in only two cases of distraction type of the LUCL, where medial bone contusion was seen in two cases. In PL dislocation of the elbow joint, we always found more severe damage of soft tissue at the medial side of the elbow joint compared to the lateral side. Lateral bone contusion was speculated to be caused by bony abutment under pathologic forearm external rotation (PFER) and medial bone contusion, by bony abutment under varus stress. In Group B, the ulnar collateral ligament was more commonly injured than the lateral ulnar collateral ligament, and lateral bone contusion accompanied most cases.

Conclusion

PL dislocation is thought to start from the medial side in contrary to PM dislocation beginning at the lateral side. If the disengagement of the coronoid process is not completed due to the insufficient valgus/varus distraction, a coronoid fracture will develop at the same time as the elbow dislocation during PFER.

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Conflict of interest

Authors have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeng Christianity Hospital, Daedo Dong 94-5, Nam Gu, Pohang, Kyeongbuk, Korea

    In Hyeok Rhyou

  2. Department of Radiology, Pohang Semyeng Christianity Hospital, Daedo-Dong 94-5, Nam Gu, Pohang, Kyeongbuk, Korea

    Young Shin Kim

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  1. In Hyeok Rhyou
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  2. Young Shin Kim
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Correspondence to In Hyeok Rhyou.

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

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  • DOI: https://doi.org/10.1007/s00167-011-1872-7

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