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Acute left elbow deformity following a fall on the hand

›DISCUSSION The radiographs demonstrated a posterior dislocation, a coronoid process fracture, and a radial head and neck fracture. A reduction was attempted under conscious sedation. Initial attempts to reduce the fractures were unsuccessful, as the elbow would spontaneously dislocate after traction was released. A posterior splint was applied with the elbow at 90° flexion, and the patient was scheduled for open reduction internal fixation. She was neurovascularly intact after attempts at reduction and splint placement. Elbow dislocations are common, accounting for 11% to 28% of all elbow injuries. Most dislocate posteriorly.1 The challenge for clinicians is recognizing associated injuries, such as coronoid process fractures, which are uncommon and often missed on plain radiographs. Additionally, clinicians should be aware of the terrible triad of the elbow, which is an ulnohumeral dislocation with associated fractures of the coronoid process and radial head.2,3 The addition of a coronoid fracture, no matter how small, to an ulnohumeral dislocation and radial head fracture dramatically increases instability and complications.1 The most common mechanism of injury is a fall on an outstretched hand.4 About 12% to 63% of elbow dislocations are associated with other injuries.4 Initially, elbow dislocations may be easy to reduce and treat, but mediumto long-term outcomes are poor.4 Conservative treatment for the triad is inadequate because of the propensity for redislocation.5 Diagnosis Obtaining a complete history is important, as high-energy trauma involves more ligamentous and osseous injuries than do lowmechanism injuries.2 In addition, discovering the mechanism of injury allows the surgeon to better predict which structures are involved.2 A good physical examination should assess for any obvious deformities, swelling, ecchymosis, fracture blisters, or open wounds.2 The clinician should palpate the patient’s elbow for tenderness, check for bony alignment, and gently assess passive range of motion.2 A complete neurologic examination should also evaluate for function of the axillary, musculocutaneous, median, ulnar, and radial nerves.2 The joints above and below the fracture should always be assessed for injury.2 Imaging studies Anteroposterior (AP) and lateral radiographs should be Acute left elbow deformity following a fall on the hand Diagnostic Imaging Review