Recurrent posterior elbow dislocation caused by congenital abnormalities in a 7-year-old child

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Abstract

BACKGROUND: Congenital posterior elbow dislocation in children is a rare and scarcely reported condition. Owing to the difficulties of an early primary diagnosis and the lack of a standardized management, we present a clinical case of an analysis of surgical treatment according to literature and based on our experience.

CLINICAL CASE: We present a case of congenital posterior elbow dislocation in a 7-year-old child. In the absence of a universal algorithm for surgical treatment, we performed an arthrotomy for visual assessment of articular surfaces, intervention on the capsule and tendons of m. brachialis, m. biceps brachii, m. brachioradialis, and modeling of the proximal epiphysis of the right radius.

DISCUSSION: We analyzed surgical treatment options and made an overview of the main stabilizers of the elbow joint that prevent elbow dislocations. There are few publications on this condition; to our knowledge, over the past 10 years, only two clinical cases of a similar pathology in children had been published. Not a single case of congenital elbow dislocation in the neonatal period has been described. We analyzed early clinical manifestations and possible causes of delayed primary diagnosis.

CONCLUSIONS: Recurrent posterior elbow dislocation of the congenital origin is associated with a functional deficiency of elbow joint stabilizers. In the neonatal period, these abnormalities are usually not detected. The first episode of dislocation may be triggered by a minor trauma without damaging the bone structures. Delayed primary diagnosis may be associated with the paucity of clinical symptoms and compensatory functionality in children. The decision on surgical correction should be based on the analysis of structural anatomical changes in the assessment, of which magnetic resonance imaging plays an important role.

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About the authors

Yaroslav N. Proshchenko

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: yar2011@list.ru
ORCID iD: 0000-0002-3328-2070
SPIN-code: 6953-3210

MD, PhD

Russian Federation, Saint Petersburg

Yulia A. Sigareva

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Author for correspondence.
Email: julsigareva@gmail.com
ORCID iD: 0000-0003-3842-2113
SPIN-code: 3911-4108

MD, clinical resident

Russian Federation, Saint Petersburg

References

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Supplementary files

Supplementary Files
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1. Fig. 4. Computed tomography scan of the right elbow joint showing hypoplasia of the head of the right radial bone, skewness of its articular surface, and dislocation of the radial bone head

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2. Fig. 6. Magnetic resonance image of the right elbow joint showing triceps brachii tendon duplication (white arrow), brachial tendon stretching (gray arrow), and humeroradial joint subluxation (black arrow)

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3. Fig. 1. Radiography of the elbow joints and forearm bones at age 4 years. Subluxation of the right radial bone head (indicated by the arrow): a, frontal view; b, lateral view

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4. Fig. 2. Clinical examination: a, b, cobbler’s chest, umbilical hernia, spine deformity, asymmetries of the shoulder girdle, scapula angles, and waist triangles (D > S), and valgus deformity at the level of the right elbow joint of 20°; c, d, amplitude of flexion and extension in the elbow joints within the normal range; e, f, restriction of rotational movements of the right forearm (supination 0°, pronation 35°); g, compensatory external rotation of the shoulder with adduction during attempts to maximize supination of the right forearm

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5. Fig. 3. Radiography of the elbow joints showing the forearm bones at age 7 years. Posterior subluxation of the forearm bones in the flexion position: a, frontal view; b, lateral view

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6. Fig. 5. Functional X-ray image during an attempt to bring the right forearm into a standard position: a, posterior dislocation of the forearm bones in the extension position; b, dislocation disappeared during flexion

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7. Fig. 7. Intraoperative presentation: a, extension in the elbow joint with supination of the forearm, posterior dislocation of the ulna, hypoplasia of the trochlear fossa of the ulnar bone, and flattening of the fissure of the trochlear humerus; b, flexion in the elbow joint during pronation of the forearm results in the reduction of the ulna; c, flattening of the fissure of the trochlear humerus, hypoplasia of the trochlear fossa of the ulnar bone, and interpronation by duplication of the triceps tendon of the shoulder in the cubital fossa of the right elbow joint

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8. Fig. 8. Control X-ray image of the right elbow joint and forearm bones before discharge

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Copyright (c) 2021 Proshchenko Y.N., Sigareva Y.A.

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