Original Contribution

Treatment of Old Unreduced Posterior Dislocation of Elbow

* Chowdhury AM, 1 Hossain MA, 2 Rahman MM,3 Ahsan K4

Clinical details, operative procedures and results obtained of 15 old unreduced posterior
dislocations of elbow joints are presented. Of which 10 cases were pre-operatively treated
by traditional bone setter, 5 cases have not seek any immediate medical treatment. At
post–operative follow up we have found 4 cases with good result, 7 cases with fair and 4
cases with poor result as per criteria set up by Krishnamoorty et al. But all cases have
regain their range of motion in comparison to preoperative range of motion

[Dinajpur Med Col J 2009 Jul; 2 (2):44-47]

Key words: Treatment, dislocation, elbow

Introduction been adopted by many authors.2,4,6,12 In this

O ld unreduced dislocation is a common

problem in Bangladesh. Most patients
seek treatment by a traditional bone
setter immediately after injury and patients
study we have presented the result of our
open reduction using V-Y musculoplasty
introduced by Speed The aim of the study was
to se the outcome of open reduction of old
with unreduced dislocation of elbow come unreduced dislocation using V-Y procedure
late to Orthopaedic surgeon. The management
of late cases of unreduced dislocation is a Methods
challenging problem for the orthopaedic This prospective study was conducted from
surgeon.1 Different views have been July 2005 to October 2007 in Orthopaedic
expressed about the role of open reduction. Department of Dinajpur Medical College
Wilson emphasized the poor result of open Hospital and in private clinics of Dinajpur. A
reduction and advocated arthodesis total of 20 dislocations of elbows were taken
particularly for labourers and arthoplasty for for study. Twelve cases were from hospitals
normal individuals.2 But more recent papers and 8 were from clinics. Dislocations
supports open reduction as a worth while associated with fracture were excluded from
procedure irrespective of age, and duration of the study. Five cases were missed from follow
dislocation.2,3,5 Speed in 1925 introduced up after 2 months of surgery. The study
Triceps lengthening by V-Y musculo-plasty review the result of 15 cases, duration of
for late open reduction where contracted follow up was 3-5 months.
Triceps hinders reduction. This technique has

1. *Dr. Md Abdul Mannan Chowdhury, Associate(cc), Department of Orthopedics, Dinajpur Medical College,
Dinajpur, Bangladesh
2. Dr, Mohammed Awlad Hossain, Assistant Registrar, Department of Orthopedics, Dinajpur Medical College,
Dinajpur, Bangladesh
3. Dr. Md. Masudur Rahman, Assistant Registrar, Department of Orthopedics, Dinajpur Medical College, Dinajpur,
Bangladesh
4. Dr. Kamrul Ahsan, Assistant Professor, Department of Orthopedics, Dinajpur Medical College, Dinajpur,
Bangladesh
*
For correspondence

Dinajpur Med Col J 2009 Jul; 2(2) 44

 Original Contribution

All the dislocations were unilateral, 10 cases Results

with right, and 5 with left elbow. Male and Clinical details of the patients are shown in
female ratio was 1.4:1. Age of the patients the table II. Results of treatment of untreated
ranged from 15 years to 40 years. All most in dislocations of elbow are shown in the figure
all cases the mechanism of injury was fall on 1. There were two cases with post operative
to a out stretched hand. Deformity and infection ended with poor result. Post
restriction of movement were the presenting operative neuropraxia was noted in 3 cases
complains. Radiologic features were those of which recovered within 6-10 weeks.
posterior or posterolateral dislocation of
elbow. Duration of dislocation was from 6-12 Discussion
weeks and there was no preoperative neuro- The majority of the dislocation of the elbow
vascualar complication. joint in our series were initially treated by
traditional bone setter. This is not very much
Through a posterolateral incision Triceps uncommon in other developing
apponeurosis was raised as a distally based countries.4,5,7,12 In most cases duration of
flap, then Triceps muscle freed dislocation was less than 12 weeks. The range
subperiosteally and the dislocated elbow was of motion achieved after open reduction is
exposed, In all cases Olecranon and coronoid much better than pre operative range of
fosa were filled up with soft tissue, After motion.
excision of all soft tissue , the medial and
lateral ligaments of the joint were divided We have performed V-Y musculoplasty
before reduction. Reduction was easily done introduced by Speed in1925. It has been
but the joint was unstable. K-wire fixation widely used by many researcher mainly it
was done between olecranon and humerus makes the exposure easier 1,2,4,[Link] this
keeping the elbow at 60-80 degree flexion. procedure the reduction is easy but joint
Periosteums with Triceps were sutured over becomes unstable , requires post operative K-
posterior aspect of humerus with V-Y strip of wire fixation and plaster immobilization for
the triceps apponeurosis to overcome the three weeks. We belief with others that
shortening. Tourniquet was released before Triceps plasty should only be performed in
closure & haemostasis was done. Closed drain cases where contracted Triceps muscle
was given in all cases. After 3 weeks both K makes reduction impossible.
were and cast removed, Collar and cuff sling
applied for another 3 weeks. Active Accurate reduction, maintenance of reduction
mobilization of the elbow was encouraged in post operative period, and post operative
after 4-5 days of removal of K-wire with therapeutic exercise are the key to success.
toleration of pain. We used broad spectrum Balchandani in his series of open reduction
antibiotics one dose preoperatively and two commented that post operative therapeutic
weeks post operatively to prevent infection. exercise is essential for good result.8 We
could not provide adequate therapeutic
At follow up post operative range of motion exercise due to lack of facilities. This may
was measured and the clinical result were explain less satisfactory result in comparison
graded according to Krishnamoorty et al to result obtained by others.1,8 There was post
(Table I) operative flexion contracture in all cases up to
300 – 600. We are satisfied with this, because
active range of movement has improved and
lay within functional range of movement 300

Dinajpur Med Col J 2009 Jul; 2(2) 45

 Original Contribution

-1300 as described by Morery et al.9 This not provide adequate physiotherapy.

range of movement is adequate for patients Considering all above we can conclude that
who are not heavy worker.9 Stewart felt that open reduction of an old unreduced dislocated
restoration of function bears a relationship to elbow is a worth while procedure. There may
the length of time between original injury and be limitation of range of movement but a
operation ,but we could not find out this useful functional range of movement can be
relationship in our cases. Our study is a achieved by open reduction and post
smaller one and is of short duration and could operative physiotherapy.

Table I: Grading of results after open reduction of elbow (after Krishnamoorty et al)

Grade Description
Good Arc of motion >90 o Flexion contracture 30 0 or less, painless and stable joint

Fair Arc of motion >60 o Flexion contracture upto30 0 – 60 0or less, painless and stable joint

Poor Arc of motion less than60 o Flexion contracture more than 60 0 pain and unstable joints

Table II: Clinical detail of the patients

Sl. No. Sex Age Duration Preoperative ROM Postoperative ROM Remarks
(Years) (Weeks)
1 M 20 06 Fixed at 200 400- 1100 Fair
Arc-700
2 F 35 10 Fixed at 100 600- 1100 Poor
Arc- 500
3 M 15 06 ROM 100 – 200 30 – 130 Good
Arc -100 Arc-1000
4 M 22 08 ROM 200 – 300 500 – 1200 Fair
Arc-100 Arc-700
5 F 18 06 Fixed at 200 30 – 120 Good
Arc 90
6 M 30 08 ROM 400 -500 ROM 70 – 120 Poor
Arc 100 Arc-500
7 F 35 12 Fixed at 200 50 – 120 Fair
Arc-700
8 F 38 06 ROM 400 -600 50 – 130 Fair
Arc 200 Arc-800
9 M 40 10 ROM 300 -500 40 – 110 Fair
Arc 200 Arc-700
10 F 16 06 Flexion at 450 30 – 120 Good
Arc-900
11 M 30 12 ROM 200- 300 70 – 110 poor
Arc-100 Arc-400
12 F 20 10 ROM fixed at 300 60 – 130 Fair
Arc-700
13 M 20 08 ROM 300 – 400 20 – 120 Good
Arc-100 Arc-1000
14 F 40 08 Fixed at 300 50 – 120 Fair
Arc-700
15 M 28 06 ROM 300 – 400 70 – 110 Poor
Arc-100 Arc-400

Dinajpur Med Col J 2009 Jul; 2(2) 46

 Original Contribution

10. Speed JS, An operation for unreduced

post dislocation of elbow, Southern Med.
Journal 1925; 18:193.
11. Edmonson AS [ed], Campbell’s operative
4 4
Orthopaedics,6th edition. Vol I louis
Good Mosby;1980:459
Fair 12. Laupattarakasem W et al. Old elbow
Poor dislocation: Joint mobility after open
reduction. J Med. [Link],1988;7:289
7 –93
13. Silva JF. Old dislocation of the elbow.
Amn R coll surgery England; 1952;22:363
- 81
Figure 1. Results of treatment of 15 cases of
unreduced dislocation of elbow

References
1. Mahaisavariya B et al, Late reduction of
Dislocated elbow. J Bone Joint Surgery
[Br]1993;75B:426 –28
2. Billet DM. Unreduced post dislocation of
elbow: J Trauma1979;19:186-8
3. Wilson JN ed Watson Jone, Fracture and
Joint Injuries, 5th edition vol-2 Edinburgh
etc: Churchill Living stone ;176:434.
4. Naido KS,. Unreduced post dislocation of
elbow. J Bone Joint Surgery
[Br]1982;64B:603 – 6
5. Krishnamoorthy S, Bose K, et al.
Treatment of old unreduced Dislocation of
elbow, Injury 1976; 39–42
6. Fowles JV, Kassab MT, Douik M.
Untreated posterior dislocation of elbow
in children, J. Bone Joint Surgery
[Am]1984;66A:921 - 6
7. Vangorder G W. Surgical approach in old
post. dislocation of elbow J. Bone Joint
Surgery1932;14:127
8. Balchandani RH, Unreduced dislocation
of elbow(abstract) JBJS 1969 51B 781
9. Morrey BFet al, A biomechanical study of
normal functional elbow motion. J. Bone
Joint Surgery [Am]1981;63A:872 - 7

Dinajpur Med Col J 2009 Jul; 2(2) 47