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Irreducible Elbow Dislocation Associated with Hill–Sachs-like Lesion over the Capitellum
Clin Should Elbow 2019;22:37-39
Published online March 1, 2019;  https://doi.org/10.5397/cise.2019.22.1.37
© 2019 Korean Shoulder and Elbow Society.

Hung-Kai Weng1,2,3, Wei-Lun Chang1,3, Ming-Long Yeh4, Wei-Ren Su1, Kai-Lan Hsu1,4,5

1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 2Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, 3Division of Orthopedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, 4Department of Biomedical Engineering, National Cheng Kung University, 5Division of Traumatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Correspondence to: Kai-Lan Hsu
Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng Li Road, Tainan 704, Taiwan
Tel: +886-6-2353535, Fax: +886-6-2766189, E-mail: dulendulen@gmail.com, ORCID: https://orcid.org/0000-0002-7576-2486
IRB approval: National Cheng Kung University Hospital (No. A-EC-107-007).
Received August 29, 2018; Revised October 26, 2018; Accepted October 30, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Irreducible dislocation of the elbow is an uncommon event. We present the case of a posterolateral elbow dislocation after a fall injury in a 67-year-old woman. A closed reduction performed in the emergency department was unsuccessful since the limited passive range of motion resulted in difficulty to perform longitudinal traction and flexion. Computed tomography images showed that the posterolateral spect of the capitellum was impacted by the tip of the coronoid process, thus appearing similar to the Hill–Sachs lesion in the humeral head. Subsequent open reduction of the elbow revealed the dislocation to be irreducible since the tip of the coronoid process had wedged into a triangular Hill–Sachs-like lesion in the capitellum. The joint was reduced by providing distal traction on the forearm, and main fragments were disengaged using digital pressure. At the 3-month follow-up, the patient reported no dislocations, and had an acceptable range of motion. Thus, we propose that to avoid iatrogenic injury to the joint or other nearby structures, irreducible dislocations should not be subjected to repeated manipulation.
Keywords : Hill-Sachs lesions; Fracture dislocation; Avulsion fracture