Open postero-lateral dislocation of the left elbow secondary to assault: A case report

INTRODUCTION AND IMPORTANCE: Simple closed lateral elbow dislocation is rare, often associated with neurovascular injury and closed reduction may be difficult. Open complex postero-lateral dislocation has not been previously reported. CASE PRESENTATION: We present a case of open left posterior lateral elbow dislocation secondary to assault with a cutlass causing an avulsion fracture of the lateral epicondyle and common extensor origin tendon which prevented congruent reduction until the avulsed fragment was fixed with a bone screw. CLINICAL DISCUSSION: The patient had hemorrhagic shock from excessive uncontrolled bleeding from the machete cut for which he was resuscitated with a blood transfusion. There was a longitudinal laceration on the lateral aspect of the elbow extending onto the proximal forearm with open posterolateral dislocation of the left elbow, avulsion of the common extensor origin with lateral epicondyle fracture and an open left wrist fracture dislocation with level VII laceration of the extensor tendon. The wound was explored under general anesthesia with generous saline irrigation, reduction of the dislocated left elbow and screw fixation of the lateral epicondyle fracture and primary wound closure plus primary repair of extensor tendons. A post-operative full arm Plaster of Paris cast was applied. Supervised active and passive range of motion exercise was commenced two weeks post-operatively. CONCLUSION: The patient had uneventful recovery with left elbow range of motion of 30 to 100 degrees two months post discharge.