Open reduction, triceps lengthening, and collateral ligaments reconstruction in neglected elbow dislocation: a case report

Abstract

Neglected elbow dislocations are common in developing countries. Neglected elbow dislocation leads to retraction of triceps muscles and collateral ligaments. This cause limitation of range of movement that is inadequate for the activities of daily living. A 48 years old man presented with stiffness on the left elbow. He fell down with arm in extension position 8 months prior to admission and was treated by a traditional bonesetter before seeking medical treatment. Active ROM of the left elbow was limited to 15ᵒ during flexion. The patient diagnosed as left elbow contracture due to neglected left elbow dislocation. Open reduction, MCL-LCL reconstruction and triceps lengthening was performed. Left elbow ROM was improved and MEPI score was good on 5 months evaluation. Open reduction surgery was done to avoid the risk of fracture or articular surface damage. The posterior approach provides good exposure to the retracted posterior structures and give easier access to perform V-Y plasty used for triceps lengthening. Collateral ligaments repair provides immediate stability and give better functional results. Docking technique was used for collateral ligaments repair using fascia lata tendon graft. Immobilization and physical rehabilitation are done to improve elbow joints range of movement. Open reduction surgery, triceps lengthening and collateral ligaments reconstruction using tendon graft from tensor fascia lata give satisfactory outcome for elbow contracture due to neglected left elbow dislocation.