Open reduction in neglected elbow dislocation in children: a case series

Main Article Content

Komang Agung Irianto
Raymond Parung
William Putera Sukmajaya

Abstract

Background
Elbow deformity in children due to neglected proper fracture management is a devastating condition. The stiffness and pain complicated the function in daily activity. Successful management of neglected elbow dislocation is a challenging problem for orthopedic surgeons. In this study, we aimed to evaluate results of open reduction for neglected elbow dislocation in children.

Case Description
This is a case series of 13-14 years old neglected elbow dislocations, for up to 15 months. Open reduction after external distractor and followed by intensive rehabilitation was implemented. Clinical and functional outcome were evaluated within 4-7 years. Initial average elbow flexion was 53,3°, extension was 0°, arc of flexion was 53,3°, arc of pronation-supination was 150° and Mayo Elbow Performance Index (MEPI) was 80. Clinical and functional outcome were evaluated within 4-7 years. At follow-up after open reduction, the improvement in whole range of movement was significant. Average elbow flexion was 118,3°, extension was 36,67°, arc of flexion was 81,67°, arc of pronation-supination was 133°. The average improvement of flexion was 65°, arc of flexion was 31,67°, and arc of pronation-supination was 8,3°. The average loss of flexion was 15,5%, arc of flexion was 44,2%, and arc of pronation-supination was 10,7% compared with uninjured side. The average Mayo Elbow Performance Index (MEPI) was 96,67; all with excellent results.

Conclusion
Planned and well execution open reduction in pediatric neglected elbow dislocation may bring back the painless movement within normal daily function.

Article Details

How to Cite
Irianto, K. A., Parung, R., & Sukmajaya, W. P. (2019). Open reduction in neglected elbow dislocation in children: a case series. Universa Medicina, 38(1), 63–68. https://doi.org/10.18051/UnivMed.2019.v38.63-68
Section
Case Report

References

Herring JA, Ho C. Upper extremity injury. In: Herring JA, editor. Tachdjian’s pediatric orthopaedics: from The Texas Scottish Rite Hospital for Children.5th ed. Philadelphia: Elsevier Saunders; 2014.p.1264-319.

Mahaisavariya B. Neglected dislocation of the elbow. In: Jain AK, Kumar S, editors. Neglected musculoskeletal injuries. 1st ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd;2010.p.318-25.

Mehta S, Sud A, Tiwari A, et al. Open reduction for late-presenting posterior dislocation of the elbow. J Orthop Surg (Hong Kong) 2007;15:15–21.

Ivo R, Mader K, Dargel J, et al. Treatment of chronically unreduced complex dislocations of the elbow. Strat Traum Limb Recon 2009;4:49–55. doi: 10.1007/s11751-009-0064-1.

Elzohairy MM. Neglected posterior dislocation of the elbow. Injury 2009;40:197–200. doi: 10.1016/j.injury.2008.05.034.

O’Driscoll SW. Elbow dislocations. In: Morrey BF, Sanchez-Sotelo J, editors. The Elbow and its disorders. 4th ed. Philadelphia: W.B. Saunders Co.;2008.p.436–49.

Islam MS, Jahangir J, Manzur RM, et al. Management of neglected elbow dislocations in a setting with low clinical resources. Orthop Surg 2012;4:177–81. doi: 10.1111/j.1757-7861.2012. 00190.x.

Lyons RP, Armstrong A. Chronically unreduced elbow dislocations. Hand Clin 2008;24:91–103. doi: 10.1016/j.hcl.2007.11.008.

Anderson RD, Haller JM, Anderson LA, et al. Surgical treatment of chronic elbow dislocation allowing for early range of motion: operative technique and clinical results. J Orthop Trauma 2017;32:1-8. doi: 10.1097/BOT.0000000000001097.

Fornalski S, Gupta R, Lee TQ. Anatomy and biomechanics of the elbow joint. Tech Hand Up Extrem Sur 2003;7:168–78.

Morrey BF, An KN. Functional evaluation of the elbow. In: Morrey BF, Sanchez-Sotelo J, editors. The elbow and its disorders. 4th ed. Philadelphia: W.B. Saunders Co;2008.p.80–91.

Donohue KW, Mehlhoff TL. Chronic elbow dislocation: evaluation and management. J Am Acad Orthop Surg 2016; 24:413-23. doi: 10.5435/JAAOS-D-14-00460.

Morrey BF. Chronic unreduced elbow dislocation. In: Morrey BF, Sanchez-Sotelo J, editors. The elbow and its disorders. 4th ed. Philadelphia: W.B. Saunders Co.; 2008.p.463-71

Coulibaly NF, Tiemdjoa H, Sanea AD, et al. Posterior approach for surgical treatment of neglected elbow dislocation. Orthop Traumatol Surg Res 2012; 98:552-8. doi: 10.1016/j.otsr.2012. 03.006.

Kapukaya A, Ucar BY, Gem M. Open reduction and Kirschner wire fixation with triceps lengthening for neglected elbow dislocations. J Orthop Surg 2013;21:178-81.

Kachnerkar NI, Lakde N, Salokhe S. Neglected old posterior dislocation of elbow: treatment and results of open reduction. Int J Orthop Sci 2017; 3:1062-6. DOI: https://doi.org/10.22271/ortho. 2017.v3.i3o.154.

Garg P, Paik S, Sahoo S, et al. A new technique for surgical management of old unreduced elbow dislocations: results and analysis. J Orthop Allied Sci 2014; 2:45-51. doi: 10.4103/2319-2585.145599.

Kembhavi RS, James B, Sugirtharaj J, et al. Old unreduced posteromedial elbow dislocation: a rare case report. Webmed Central Orthopaedics 2015;6:WMC004823.

Maru ND, Sayani K, Ramesh. A rare case of pediatric neglected elbow dislocation treated with speed procedure. Gujarat Med J 2015;70:103-4.