A case report of children's divergent dislocation of the elbow and review of literature

BACKGROUND The divergent dislocation of the elbow is not common in children, and the imaging is difficult and challenging. This often leads to misdiagnosis or inappropriate treatment. The literature has reported a total of 19 cases currently. METHODS A 10-year-old girl with divergent dislocation of the elbow was admitted in our department in November 2013. When playing basketball, her right elbow was injured on the concrete floor. After injury, her right elbow joint became severely swollen, with obvious deformity. The anteroposterior X-ray of elbow showed right olecranon and coronoid fractures, the proximal radioulnar separation, and displacement; the lateral X-ray showed the posterior dislocation of right elbow. RESULTS Under local anesthesia, right elbow manual reduction was performed, and after reduction, 3-dimensional computed tomography reconstruction displayed good reduction of the elbow dislocation. The fracture of coronoid displaced minimally, but the olecranon fracture showed great displacement which underwent the open reduction and internal fixation. Postoperatively, a plaster splint was applied for protection, with regular outpatient follow-ups. At the end of the normal follow-up, the active ROM of the right elbow joint was 5° to 130° and with normal rotation. CONCLUSION Therefore, through the treatment of this case and the literature review, we believe that for children, most divergent dislocations of the elbow may achieve a better clinical result with closed reduction, and we also believe that after surgery or closed reduction, in the follow-up, proper function exercise is an important condition for the rehabilitation of children. For such patients, correct diagnosis and timely treatment can help to avoid joint dysfunction of elbow.