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Transverse Divergent Dislocation of Elbow in a Child: A Case Report and Review of Current Literature

George, Harvey L. MS, MRCS*; Unnikrishnan, Puthanveetil Nithin MBBS, MRCS*; Bass, Alfie FRCS*; Waseem, Mohammed FRCS; Brownson, Peter FRCS

doi: 10.1097/PEC.0b013e3182187438
Illustrative Cases

We present a case report on transverse divergent dislocation of the elbow, highlighting the spatial relation among the proximal radius, ulna, and distal humerus in this rare pediatric elbow injury and reasons leading to misinterpretation of radiographs. Elbow dislocation is a rare injury in children. It comprises only 6% of pediatric elbow injuries. Most pure dislocations are posterior, but they can occur in any direction. Divergent dislocation of the elbow is a subgroup of posterior dislocation, which is extremely rare. It is important that the pediatric emergency physician is aware, able to identify, and manage this injury. It is defined as a specific elbow dislocation in which the distal humerus is forced between the proximal radius and ulna, resulting in the divergence of the proximal forearm bones. Joint laxity is said to be a predisposing cause in pediatric age group. Atraumatic divergent dislocation of the elbow has been reported in the adults with rheumatoid arthritis. Imaging is challenging because there is no defined specific radiological views, therefore making the diagnosis difficult. This often leads to misdiagnosis or inappropriate treatment. A thorough understanding of mechanism of injury and basis for atypical radiological findings will help in identifying the injury early, and the simple Thompson technique to relocate the elbow will give an excellent functional outcome.

From the *Department of Trauma and Orthopaedics, Royal Liverpool Children's Hospital (Alder Hey Hospital), Liverpool; †Department of Trauma and Orthopaedics, Macclesfield Hospital, Macclesfield; and ‡Department of Trauma and Orthopaedics, Royal Liverpool and Broadgreen University Hospitals, Liverpool, England, UK.

Reprints: Puthanveetil Nithin Unnikrishnan, MBBS, MRCS, Department of Trauma and Orthopaedics, Royal Liverpool Children's Hospital (Alder Hey Hospital), Eaton Rd, Liverpool, L12 3LB, England, UK (e-mail: nithinunni@gmail.com).

© 2011 Lippincott Williams & Wilkins, Inc.