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El-bow Out of This One
A 65-year-old male presents with left elbow and forearm pain and deformity after falling on the soccer field when attempting a scissor kick. He fell onto his outstretched arm with his elbow flexed and supinated.
El-bow Out of This One
Author: Brian J. Franklin, MD, MBA
Peer-Reviewer: R. Conner Dixon, MD, CAQ-SM
Final Editor: Alex Tomesch, MD, CAQ-SM
A 65-year-old male presents with left elbow and forearm pain and deformity after falling on the soccer field when attempting a scissor kick. He fell onto his outstretched arm with his elbow flexed and supinated.
Image 1. AP and lateral radiograph of the left forearm and lateral/oblique radiograph of the left elbow respectively. Author’s own images.
What is the diagnosis?
Oblique, bayonetting* mid-shaft radial fracture with associated ulnohumeral dislocation
*Instead of using the term “bayonetting,” this fracture could alternatively be described as a mid-shaft radial fracture with anterior and ulnar displacement (of the distal fragment).
- Pearl: While not the case here, certain radial and ulnar shaft fractures with associated injuries have eponyms associated with them:
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A Galeazzi fracture involves the distal one-third of the radial shaft with associated injury to the distal radio-ulnar joint (DRUJ) [1].
- A Monteggia fracture involves the proximal one-third of the ulnar shaft with associated dislocation of the radial head [2].
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Image 2: Labeled AP view of the forearm and lateral/oblique view of the elbow, author’s own images and annotations.
References
[1] Atesok KI, Jupiter JB, Weiss APC. Galeazzi fracture. J Am Acad Orthop Surg. 2011;19(10):623-633. doi:10.5435/00124635-
[2] Delpont M, Louahem D, Cottalorda J. Monteggia injuries. Orthop Traumatol Surg Res OTSR. 2018;104(1S):S113-S120. doi:10.1016/j.otsr.2017.04.014
[3] Gottlieb M, Schiebout J. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. 2018;54(6):849-854. doi:10.1016/j.jemermed.2018.
[4] Flynn H, Solarz MK, Rehman S. Forearm Fractures: Diagnosis and Contemporary Treatment Strategies. Instr Course Lect. 2022;71:303-312.
[5] MD WD MD CAQ SM, Max Hockstein. SplintER Series: Common ED Splint Techniques 104. ALiEM. Published July 4, 2018. Accessed August 20, 2023. https://www.aliem.com/
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