Osborne-Cotterill Lesion a Forgotten Injury: Review Article and Case Report

A Retrospective Study on Traumatic Elbow Dislocation in Adults in a Tertiary Hospital in Riyadh, Saudi Arabia

Background This retrospective chart review aimed to ascertain the frequency and characteristics of radial head fractures in adults who presented to our emergency department with elbow dislocation. Methodology This study was conducted in a single tertiary trauma center in Riyadh, Saudi Arabia, between July 2015 and July 2020 to identify traumatic elbow dislocation in adults. Patients were identified after thoroughly examining the hospital's electronic X-ray database. In addition, computed tomography (CT) was used to assess complete ulnohumeral joint dislocation. In total, 80 patients between the ages of 18 and 65 were evaluated for a radial head fracture. Various variables were examined. Results Of the 80 patients included, the mean age with standard deviation was 36.9 ± 8.8 years, and all patients were males. Nearly all patients with elbow dislocation had some form of posterior dislocation, including posterolateral (81.3%), posterior (10%), and posteromedial (7.5%) dislocation. The radial head fracture was identified in 48 (60%) cases. Radiographs were sufficient to diagnose 91.3% of radial head fractures, while the remaining 8.8% required additional CT. Conclusions Based on X-ray or CT findings, radial head fractures were found in more than half of traumatic elbow dislocations. In addition, most cases were diagnosed as an elbow dislocation and radial head fracture using only plain radiography, while some required additional CT. Based on these findings, we recommend routine CT to detect suspected elbow dislocation and avoid missing subtle injuries.

[Clinical treatment of dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint]

OBJECTIVE

To analyze the possible injury mechanisms in patients with dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint, and to discuss their treatment and prognosis.

METHODS

Retrospective analysis was made on the clinical data of 4 patients with dorsal avulsion fracture of the capitellum combined with medial or posterior medial dislocation of the elbow joint admitted between September 2014 and September 2020, including 3 males and 1 female with an average age of 20.7 years (range, 13-32 years). There were 2 cases of dorsal avulsion fracture of the capitellum combined with medial dislocation of the elbow joint and 2 cases of dorsal avulsion fracture of the capitellum and anterior medial fracture of the coronoid process combined with posterior medial subluxation of the elbow joint. Closed reduction was performed in 3 patients with fresh fracture combined with dislocation, then 2 cases were fixed with tension band and 1 case was fixed with tension band combined with Acumed coronoid anatomic plate. And in patient with old fracture nonunion, the coronoid process was fixed with 1 screw, then the humeral sclerotic bone mass was removed, and finally the lateral collateral ligament was repaired and a hinged external fixator was added.

RESULTS

All the incisions healed by first intention without early complications such as infection or peripheral nerve injury. The 4 patients were followed up 13-30 months (mean, 20.8 months). The fractures all healed with a healing time of 70-90 days (mean, 79.5 days). At 6 months after operation, heterotopic ossification was seen in the posterior aspect of the right elbow joint in 1 case, and the alkaline phosphatase level was normal (67 U/L); the tension band was removed to clear the heterotopic ossification and the elbow joint was released. The rest of the patients had no heterotopic ossification. At last follow-up, all patients had good functional recovery of the elbow joint, with a Mayo score of 85-100 (mean, 92.5), and the excellent and good rate was 100%. The elbow flexion range of motion was 120°-135°, the extension range of motion was 10°-20°, and the pronation and supination range of motion were all 75°-85°.

CONCLUSION

Dorsal avulsion fractures of the capitellum combined with medial or posterior medial dislocation of the elbow may be due to simple varus stress. If an anteromedial coronoid facet fracture also occurs, it may be for the varus posteromedial rotatory instability, which is the opposite mechanism to that of an Osborne-Cotterill lesion. For fresh dorsal avulsion fractures of the capitellum, tension band fixation can be used with good results.

Elbow Osteochondral Allograft Transplantation and Lateral Ulnar Collateral Ligament Repair with Internal Brace: A Case Report

CASE

A 23-year-old woman with an Osborne-Cotterill lesion and posterolateral rotatory instability (PLRI) of the elbow was treated with osteochondral allograft transplantation (OCA) and lateral ulnar collateral ligament (LUCL) repair with internal brace. Two years after surgery, she reported resolution of pain and returned to all recreational activities. She reported no mechanical symptoms and no episodes of postoperative instability.

CONCLUSION

PLRI can present with an Osborne-Cotterill lesion in addition to LUCL injury. The purpose of this case report was to describe the use of OCA to manage bony defects in the capitellum in addition to LUCL repair for patients with PLRI.