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Unstable elbow dislocation with coronoid process fracture associated with distal radius fracture: a case report and review of the literature

  • Ali Hassan ChamseddineEmail author
  • Hadi K. Zein
  • Houssam R. Hamdan
  • Bilal N. Khalil
  • Bilal M. Obeid
Case Report

Abstract

We present a case of distal radial shaft fracture associated with elbow dislocation and coronoid process fracture. The associated coronoid fracture was initially missed. Closed reduction of the elbow and open reduction with internal fixation of the radial fracture were achieved immediately after admission. Radiographic control 3 days later showed that the elbow was redislocated into the cast. A careful reevaluation of the radiographs disclosed the coronoid fracture. An anterior approach of the elbow permits to reduce and fix the coronoid process. In addition, a hinged external fixator was applied to maintain concentric elbow reduction, and to protect the coronoid fracture fixation and the capsulo-ligamentous healing, while early elbow motion was started. The final result at 10-year follow-up was excellent both clinically and radiologically. According to our knowledge, a similar presentation of distal radial shaft fracture with ipsilateral unstable complex elbow dislocation and fracture of the coronoid process has never been described in the previous literature.

Keywords

Coronoid process Complex elbow instability Elbow fracture–dislocation Radius fracture Hinged external fixator 

Notes

Conflict of interest statement

No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

References

  1. 1.
    Al-Aradi AJ, Wong-Chung J, Bagali M (1998) Expanded SMC classification of ulna and radius fractures associated with pericubital dislocations. J Bahrain Med Soc 10:163–166Google Scholar
  2. 2.
    Bado JL (1967) The Monteggia lesion. Clin Orthop Relat Res 50:71–86CrossRefPubMedGoogle Scholar
  3. 3.
    Barquet A (1984) Posterior dislocation of the ulna at the elbow with associated fracture of the radial shaft. Injury 15:390–392CrossRefPubMedGoogle Scholar
  4. 4.
    Beach PM, Hewson JS (1966) Elbow dislocation with comminuted fracture of the proximal radial shaft. Thoughts on the mechanism. Am J Surg 112:941–942CrossRefPubMedGoogle Scholar
  5. 5.
    Benjamin A (1976) Injuries of the forearm. In: Wilson JN (ed) Watson-Jones’ fractures and joint injuries, vol 2, 5th edn. Churchill Livingstone, Edinburgh, pp 666–726Google Scholar
  6. 6.
    Broberg MA, Morrey BF (1987) Results of treatment of fracture–dislocations of the elbow. Clin Orthop Relat Res 216:109–119PubMedGoogle Scholar
  7. 7.
    Cherif MR, Chehimi A, Ben Ghozlen R, M’Barek M (2002) Luxation traumatique de la tête radiale associée à une fracture diaphysaire du radius: présentation d’un cas. Acta Orthop Belg 68:529–531PubMedGoogle Scholar
  8. 8.
    Chia Chin Soon J, Prem kumar V, Satkunanartham K (1996) Elbow dislocation with ipsilateral radial shaft fracture: an unusual outcome. Clin Orthop Relat Res 329:212–215CrossRefGoogle Scholar
  9. 9.
    Closkey RF, Goode JR, Kirschenbaum D, Cody RP (2000) The role of the coronoid process in elbow stability. J Bone Jt Surg Am 82:1749–1753Google Scholar
  10. 10.
    Cobb TK, Morrey BF (1995) Use of distraction arthroplasty in unstable fracture dislocation of the elbow. Clin Orthop Relat Res 312:201–210PubMedGoogle Scholar
  11. 11.
    Crenshaw A (1998) Fractures of shoulder girdle, arm and forearm. In: Canale T (ed) Campbell’s operative orthopaedics, vol 3, 9th edn. Mosby, St. Louis, pp 2281–2362Google Scholar
  12. 12.
    Darlis NA, Kotsovolos ES, Zalavras CG, Mavrodondidis AN (2004) Ipsilateral radial shaft, head, and medial epicondyle fractures. Case report. J Orthop Trauma 18:238–240CrossRefPubMedGoogle Scholar
  13. 13.
    Domingo A, Fernandez-Valencia JA, Saz L, Prat S, Arandes JM (2008) Elbow dislocations associated with radial shaft fractures: a case report and review of the literature. J Trauma 64:221–224CrossRefPubMedGoogle Scholar
  14. 14.
    Doornberg JN, Ring D (2006) Coronoid fracture patterns. J Hand Surg Am 31:45–52CrossRefPubMedGoogle Scholar
  15. 15.
    Dürig M, Müller W, Rüedi TP, Gauer EF (1979) The operative treatment of elbow dislocation in the adult. J Bone Jt Surg Am 61:239–244Google Scholar
  16. 16.
    El-Andaloussi Y, Bendriss A, Bennouna D, Ouarab M (2008) Fractures concomittantes du radius et du scaphoide associées à une luxation du coude. Chir Main 27:180–182CrossRefPubMedGoogle Scholar
  17. 17.
    Evans EM (1949) Pronation injuries of the forearm. J Bone Jt Surg Br 31:578–588Google Scholar
  18. 18.
    Fleming FJ, Flavin R, Poynton AR, Glynn T (2004) Elbow dislocation with ipsilateral open radial and ulnar diaphyseal fractures: a rare combination. Injury 35:90–92CrossRefPubMedGoogle Scholar
  19. 19.
    Forthman C, Henket M, Ring DC (2007) Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament. J Hand Surg Am 32:1200–1209CrossRefPubMedGoogle Scholar
  20. 20.
    Frazier JL, Insler HP, Bushmann WR (1991) Monteggia type I equivalent lesion: diaphyseal ulna and proximal radius fracture with a posterior elbow dislocation in a child. J Orthop Trauma 5:373–375CrossRefPubMedGoogle Scholar
  21. 21.
    Goldberg HD, Young JWR, Reiner BI, Resnik CS, Gillespie TE (1992) Double injuries of the forearm: a common occurrence. Radiology 185:223–227PubMedGoogle Scholar
  22. 22.
    Haddad FS, Manktelow ARJ, Dorrell JH (1995) Radial head dislocation with radial shaft fracture. Injury 26:502–503CrossRefPubMedGoogle Scholar
  23. 23.
    Hassman GC, Brunn F, Neer CSII (1975) Recurrent dislocation of the elbow. J Bone Jt Surg Am 57:1080–1084Google Scholar
  24. 24.
    Hung SC, Huang CK, Chiang CC, Chen TH, Chen WM, Lo WH (2003) Monteggia type I equivalent lesion: diaphyseal ulna and radius fractures with a posterior elbow dislocation in an adult. Arch Orthop Trauma Surg 123:311–313CrossRefPubMedGoogle Scholar
  25. 25.
    Josefsson PO, Johnell O, Gentz CF (1984) Long term sequelae of simple dislocation of the elbow. J Bone Jt Surg Am 66:927–930Google Scholar
  26. 26.
    Josefsson PO, Gentz CF, Johnell O, Wendeberg B (1987) Surgical versus nonsurgical treatment of ligamentous injuries following dislocation of the elbow joint. A prospective randomized study. J Bone Jt Surg Am 69:605–608Google Scholar
  27. 27.
    Josefsson PO, Gentz CF, Johnell O, Wendeberg B (1989) Dislocations of the elbow and intra-articular fractures. Clin Orthop Relat Res 246:126–130PubMedGoogle Scholar
  28. 28.
    Jupiter JB, Ring D (2002) Treatment of unreduced elbow dislocations with hinged external fixation. J Bone Jt Surg Am 84:1630–1635Google Scholar
  29. 29.
    Kose O, Durakbasa MO, Islam NC (2008) Posterolateral elbow dislocation with ipsilateral radial and ulnar diaphyseal fractures: a case report. J Orthop Surg 16:122–123Google Scholar
  30. 30.
    McKee MD, Schemitsch EH, Sala MJ, O’Driscoll SW (2003) The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg 12:391–396CrossRefPubMedGoogle Scholar
  31. 31.
    Mehara AK, Bahn S (1993) Ipsilateral radial head dislocation with radial shaft fracture: a case report. J Trauma 35:958–959CrossRefPubMedGoogle Scholar
  32. 32.
    Mehlhoff TL, Noble PC, Bennett JB, Tullos HS (1988) Simple dislocation of the elbow in the adult. Results after closed treatment. J Bone Jt Surg Am 70:244–249Google Scholar
  33. 33.
    Morrey BF (1997) Complex instability of the elbow. J Bone Jt Surg Am 79:460–469Google Scholar
  34. 34.
    O’Driscoll SW, Morrey BF, Korinek S, An KN (1992) Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res 280:186–197PubMedGoogle Scholar
  35. 35.
    O’Driscoll SW, Jupiter JB, King GJW, Hotchkiss RN, Morrey BF (2000) The unstable elbow. J Bone Jt Surg Am 82:724–738CrossRefGoogle Scholar
  36. 36.
    Protzman RR (1978) Dislocation of the elbow. J Bone Jt Surg Am 60:539–541Google Scholar
  37. 37.
    Rao SB, Patrick J (1991) Isolated fracture–dislocation of the proximal radius. A previously undescribed injury. Injury 22:484–485CrossRefPubMedGoogle Scholar
  38. 38.
    Regan W, Morrey BF (1989) Fractures of the coronoid process of the ulna. J Bone Jt Surg Am 71:1348–1354Google Scholar
  39. 39.
    Ring D, Jupiter JB (1998) Fracture–dislocation of the elbow. J Bone Jt Surg Am 80:566–580CrossRefGoogle Scholar
  40. 40.
    Ring D, Jupiter JB (2000) Reconstruction of posttraumatic elbow instability. Clin Orthop Relat Res 370:44–56CrossRefPubMedGoogle Scholar
  41. 41.
    Ring D, Jupiter JB, Zilberfarb J (2002) Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Jt Surg Am 84:547–551Google Scholar
  42. 42.
    Ring D, Hannouche D, Jupiter JB (2004) Surgical treatment of persistent dislocation or subluxation of the ulno-humeral joint after fracture–dislocation of the elbow. J Hand Surg Am 29:470–480CrossRefPubMedGoogle Scholar
  43. 43.
    Selesnick FH, Dolitsky B, Haskell S (1984) Fracture of the coronoid process requiring open reduction with internal fixation. A case report. J Bone Jt Surg Am 66:1304–1306Google Scholar
  44. 44.
    Shukur MH, Noor MA, Moses T (1995) Ipsilateral fracture dislocation of the radial shaft head associated with elbow dislocation: case report. J Trauma 38:944–946CrossRefPubMedGoogle Scholar
  45. 45.
    Simpson JM, Andreshak TG, Patel A, Jackson WT (1991) Ipsilateral radial head dislocation and radial shaft fracture. A case report. Clin Orthop Relat Res 266:205–208PubMedGoogle Scholar
  46. 46.
    Walker R, Tanner J (1982) Fracture of the proximal shaft of the radius associated with posterior dislocation of the elbow. A case report and review of the literature. Clin Orthop Relat Res 168:35–37PubMedGoogle Scholar
  47. 47.
    Watson-Jones R (1955) Fractures and joint injuries, vol 2, 4th edn. Churchill Livingstone, Edinburgh, pp 585–641Google Scholar
  48. 48.
    Watson-Jones R (1976) Injuries of the elbow. In: Wilson JN (ed) Watson-Jones’ fractures and joint injuries, vol 2, 5th edn. Churchill Livingstone, Edinburgh, pp 604–665Google Scholar
  49. 49.
    Wong-Chung J, Jahromi I, Aradi AJ (1998) Fracture of the upper radius with ipsilateral dislocations of the elbow and superior radio-ulnar joint. A case report. Int Orthop 22:62–64CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ali Hassan Chamseddine
    • 1
    Email author
  • Hadi K. Zein
    • 1
  • Houssam R. Hamdan
    • 1
  • Bilal N. Khalil
    • 1
  • Bilal M. Obeid
    • 1
  1. 1.Department of Orthopaedic Surgery, Sahel General HospitalUniversity Medical CentreBeirutLebanon

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