Open Posterolateral Elbow Dislocation in an Adult after Low-Energy Trauma: A Case Report Highlighting Diagnostic and Operative Considerations.

Abstract

Introduction: Open elbow dislocations are rare injuries in adults, accounting for <2% of cases, and may occur even after low-energy mechanisms. Their presentation can be subtle, particularly when periarticular wounds appear benign, leading to delayed recognition of joint violation. Early identification of intra-articular air and associated soft-tissue injury is essential to guide timely operative management. This case highlights the diagnostic challenges and surgical considerations associated with an uncommon open posterolateral elbow dislocation following a low-energy fall.

Case report: A middle-aged man presented after slipping and landing on an outstretched right arm, resulting in a posterolateral elbow dislocation with an associated medial elbow laceration. The joint was reduced in the emergency department, and the wound was irrigated and repaired. Subsequent computed tomography (CT) imaging revealed intra-articular air concerning for an open dislocation. The patient underwent operative irrigation and debridement, during which complete avulsion of the flexor pronator mass from the medial epicondyle was identified and repaired. The elbow remained stable intraoperatively and was immobilized in a long arm splint.

Result: The patient received 24 h of intravenous antibiotics and was discharged the following day. At 2 weeks' follow-up, he began a range of motion exercises, and by 4 weeks demonstrated excellent motion and a stable elbow joint. He continued non-surgical management with favorable early recovery.

Conclusion: Open elbow dislocations in adults may occur after low-energy trauma and require a high index of suspicion, particularly when periarticular wounds are present. CT evaluation for intra-articular air is critical for identifying joint violation, and early operative washout with soft-tissue repair is essential to prevent infection and instability. This case underscores the importance of timely recognition and management to achieve optimal functional outcomes.