Acute elbow dislocation: comparison between magnetic resonance imaging and intra-operative finding of ligament injury
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ORIGINAL PAPER
Acute elbow dislocation: comparison between magnetic resonance imaging and intra-operative finding of ligament injury Luigi Tarallo 1 & Giovanni Merolla 2,3 & Giuseppe Porcellini 1 & Maria Grazia Amorico 4 & Gianmario Micheloni 1 & Michele Novi 1 & Ettore Di Giovine 1 & Fabio Catani 1 Received: 9 July 2020 / Accepted: 9 November 2020 # SICOT aisbl 2020
Abstract Purpose The aim of this current study was to assess elbow ligament tears after dislocation using magnetic resonance imaging (MRI) and to correlate any pre-operative imaging with intra-operative findings of elbow ligament tears. Methods We prospectively included 32 patients with acute elbow dislocation investigated by MRI at a means of five days from dislocation. A simple elbow dislocation was diagnosed in 14 patients (44%); associated bone injuries were identified in 18 elbows (56%). Surgical repair of elbow ligaments was carried out in 23 patients, and nine cases were treated non-operatively. A blinded MRI evaluation of all 32 elbows was performed by an orthopaedic surgeon (rater 1) and a musculoskeletal radiologist (rater 2). Results Inter-rater agreement for MRI evaluation of 32 was poor for lateral ulnar collateral ligament (LUCL) tears, fair for radial collateral ligament (RCL), moderate for annular ligament (AL), and fair for ulnar collateral ligament (UCL). All tears were reported as complete by rater 1; 13/32 partial tears were identified by rater 2 (LUCL = 2, RCL = 2, UCL = 9). Correlation between surgical and MRI findings showed good inter-rater agreement for LUCL and AL tears in both raters. Agreement for RCL tear was poor for rater 1 and fair for rater 2; agreement for UCL tear was fair for rater 1 and poor for rater 2. Intra-operative findings showed ten radial head fractures (RHFs) and ten coronoid fractures (CFs). LUCL tears were found in the four cases of type II RHFs and in 3/4 cases of CFs. Bone injuries and ligament tears were not significantly associated. Conclusion MRI scan supported surgeons to identify soft tissue injuries and to address the most suitable surgical approach after acute elbow dislocation. Inter-observer agreement for intra-operative findings was high for LCL complex injuries and poor for UCL. Keywords Elbow dislocation . Magnetic resonance imaging . Ligament tears . Intra-operative finding
Introduction
* Giovanni Merolla [email protected]; [email protected] 1
Department of Orthopaedic and Traumatology, University of Modena and Reggio Emilia, Modena, Italy
2
Shoulder and Elbow Unit, Cervesi Hospital, Cattolica, AUSL della Romagna, Via L. v. Beethoven 46, 47841 Cattolica, Italy
3
International Doctorate School (PhD) in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
4
Department of Radiology, University of Modena and Reggio Emilia, Modena, Italy
The elbow joint is the second most common site of dislocation in adults after the shoulder joint, with an annual incidence of 5.2 per 100,000 people per year [1]. Simple elbow dislocations
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