Anterior elbow fracture dislocation with ulnar nerve palsy in a six-year-old child

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Background. Anterior elbow fracture dislocation is rare, especially in paediatric age group. Of the reported cases to date, three-quarter were posterior dislocation of the elbow. Anterior elbow dislocation is rarely reported, with incidence of only <2%.

Clinical case. A 6-year-old girl presented to casualty with left elbow deformity and pain after she tripped and fell in the toilet. Ulnar clawing was present with reduced sensation over ulnar nerve distribution. No wound was found, distal pulses and circulation were good. The X-rays showed anterior dislocation of the left elbow with olecranon fracture. Closed manual reduction was attempted but failed. Open reduction and percutaneous K-wire insertion under general anaesthesia was performed. Medial approach of the elbow was done. Intra-operatively ulnar nerve was found impinged by the distal ulnar fragment but was in continuity. The transverse olecranon fracture was fixed with two K-wires and the radial head was reduced. Ulnar nerve was mobilised until tension-free. Ulnar collateral ligament was repaired. The elbow was immobilised with a splint. Ulnar claw was resolved at 2 weeks. The fracture heals and the K-wires were removed at 6 weeks. At 8 weeks, range of movement of the elbow was full. The elbow was stable in varus and valgus.

Discussion. Anterior elbow dislocation is a high energy trauma and one should be cautious of neurovascular injury. There was no clear recommendation in the literature regarding surgical approach. We chose medial approach of the elbow for ulnar nerve exploration and olecranon fixation.

Conclusion. This rare injury should be treated with high index of suspicious. Surgical approach should be tailored individually according to the instability of the elbow joint and neurovascular status, as in this case was the posteromedial instability associated with ulnar nerve palsy.

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About the authors

Nur Ayuni Khirul Ashar

Universiti Putra Malaysia; Hospital Serdang; Universiti Teknologi MARA (UiTM), Jalan Hospital

ORCID iD: 0000-0003-3556-0721

Malaysia, Serdang, Selangor; Jalan Puchong, Kajang, Selangor; Sungai Buloh, Selangor

D-r, MBBS (UiTM), Postgraduate student & Medical Officer of the Department of Orthopaedic, Faculty of Medicine and Health Sciences

Siew Khei Liew

Universiti Putra Malaysia

Author for correspondence.
ORCID iD: 0000-0003-4419-1382

Malaysia, Serdang, Selangor

D-r, MBBS (UM), MS ORTH (UM), Orthopaedic Surgeon, Hand and Reconstructive Microsurgery Unit of the Department of Orthopaedic, Faculty of Medicine and Health Sciences

Nur Syahirah Azmi

Hospital Serdang

ORCID iD: 0000-0002-4057-3749

Malaysia, Jalan Puchong, Kajang, Selangor

D-r, MB BCh (Mansoura University), Medical Officer of the Department of Orthopaedic

Raymond Dieu Kiat Yeak

Universiti Putra Malaysia

ORCID iD: 0000-0001-8232-5359

Malaysia, Serdang, Selangor

D-r, MB BCh BAO (PMC), MS ORTH (UM), Orthopaedic Surgeon, Sports Surgery Unit of the Department of Orthopaedic, Faculty of Medicine and Health Sciences

Rahul Lingam

Hospital Serdang

ORCID iD: 0000-0002-0546-3077

Malaysia, Jalan Puchong, Kajang, Selangor

D-r, MD (KSMU), Doctor of Medicine, Medical Officer of the Department of Orthopaedic

Raimi Adam Chen

Hospital Serdang

Scopus Author ID: 0000-0003-0362-521X

Malaysia, Jalan Puchong, Kajang, Selangor

D-r, MD (RSMU), Doctor of Medicine, Medical Officer of the Department of Orthopaedic


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Supplementary files

Supplementary Files Action
Fig. 1. Plain radiograph of left elbow showing anterior dislocation of elbow associated with olecranon fracture

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Fig. 2. Post-operative plain radiograph of left elbow. Dislocation has been reduced and K-wires were used to stabilise olecranon fracture

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Fig. 3. Fracture united at 6 weeks post-op.

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Fig. 4. Range of movement of patient’s left elbow at 8 weeks post-op.: a — flexion; b — extension; c — supination; d — pronation

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Copyright (c) 2020 Ashar N., Liew S., Azmi N., Yeak R., Lingam R., Chen R.

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