Surgical treatment of elbow fracture-dislocations seen in children and adolescents

Objective: We evaluated surgical indications and radiologic features of elbow fracture-dislocations in children and adolescents.

Methods: Thirteen patients (12 boys, 1 girl; mean age 13 years; range 6 to 17 years) with elbow fracture-dislocations were treated surgically. Coexisting fractures included medial epicondyle fractures (n=5), medial and lateral epicondyle fractures (n=3), radial head and olecranon fractures (n=2), radial head and medial epicondyle fractures (n=1), lateral condyle fracture (n=1), and fracture of the coronoid process (n=1). Eleven dislocations were closed, two were open. Open reduction and Kirschner wire fixation were performed in all the patients. Posterior (n=6), medial (n=5), anteromedial, and lateral incisions were used. Active range of motion exercises were initiated following the removal of sutures. Above-elbow cast was applied for three weeks. The mean follow-up period was 38 months (range 7 to 58 months). The results were evaluated with the use of the Mayo elbow performance score.

Results: Ten patients had satisfactory (very good or good) results, while two patients with open dislocations and ipsilateral major injuries, and one patient who developed myositis ossificans postoperatively had unsatisfactory (moderate or bad) results. No postoperative nerve injuries were detected.

Conclusions: The surgical indications for fracture-dislocations of the elbow in children and adolescents are the presence of intraarticular loose bodies or instability after reduction. The presence of open dislocation or ipsilateral major injuries are associated with unsatisfactory results.