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Elbow Dislocations: A Review Ranging from Soft Tissue Injuries to Complex Elbow Fracture Dislocations

DOI: 10.1155/2013/951397

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This review on elbow dislocations describes ligament and bone injuries as well as the typical injury mechanisms and the main classifications of elbow dislocations. Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Special emphasis is put on injuries to the medial ulnar collateral ligament (MUCL) and on posttraumatic elbow stiffness. 1. Introduction Even simple elbow dislocations do not necessarily represent benign injuries. Anakwe showed in a retrospective trial with almost 180 patients that simple elbow dislocations caused considerable residual pain and stiffness in 62% and 56% of the patients, respectively [1]. According to Anakwe, elbow dislocations can be defined as simple if an elbow is stable when put through full range of motion after repositioning. Typically, simple elbow dislocations occur when a person falls onto an outstretched hand. Axial compression on the elbow in combination with supination and valgus stress primarily result in the rupture of the lateral ulnar collateral ligament (LUCL), which may cause posterolateral subluxation (Figure 1(a)). Extended elbow dislocations often involve severe ruptures with anterior and posterior capsule distractions followed by muscle injuries and, finally, by total elbow dislocation with rupture of the anterior MUCL (Figure 1(b)). This ligament tends to rupture in two stages; that is, the rupture of the posterior MUCL (Figure 1(a)) is followed by the rupture of the anteromedial bundle of the ligament complex [2, 3] (Figure 1(b)). This trauma mechanism has been described by O’Driscoll, who has also classified posttraumatic elbow instability according to the following five criteria: the articulations involved, the direction of the displacement, the degree of the displacement, the timing, and the presence or absence of associated fractures [3]. Fractures of a bony structure with a buttress function immediately result in elbow instability. The function of the medial ulnar collateral ligament complex and particularly its role in complex elbow dislocations has been investigated intensively. However, single injuries to the MUCL seem to be rare. Figure 1: (a) Dorsal view to an anatomic elbow preparation. The posterior lateral ulnar collateral ligament (LUCL) and the posterior medial ulnar collateral ligament (MUCL) are visible. The posterior part of the ligamentum annulare with its insertion to the ulnar and the above lying distal part of the LCL can be seen. (b) Ventral view to an anatomic elbow preparation with demonstration of

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