A 44-year old man presented to us with a high velocity motorbike accident after a head-on collision with a truck. On arrival to the A&E, he was alert and conscious but was hypotensive and tachycardic. He complained of pain in the groin and both knees. There was no significant past history. Examination revealed extensive bruising of the pelvic region, scrotal swelling and bilateral knee effusions. Initial radiographs showed an open book type pelvic fracture but no other bony injuries were identified. Stress views of the knees in theatre revealed ligamentous laxity bilaterally. The pelvis was stabilised with an external fixator after initial resuscitation and splints applied to both knees.

12 hours later, the patient complained of pain in the right elbow. There was no previous history of elbow injury or arthritis. On examination, there was minimal swelling over the elbow and tenderness over the radial head. There was a flexion attitude of the right elbow. Although he had good flexion and extension of the elbow, forearm pronation and supination were restricted and painful. There was no evidence of posterior interosseus nerve palsy. Radiographs showed an anterolateral dislocation of the radial head with no associated fractures of the radius, ulna or disruption of the distal radioulnar joint. (Figure 1 &2) Closed reduction was achieved by supinating the forearm and applying pressure on the radial head following which immobilisation was done in an above elbow plaster with the forearm in supination and elbow in 90 degrees of flexion. (Figure 3 &4) The elbow was tested for stability post reduction and was found to be stable. On screening there was no evidence of a coronoid or radial head fracture. Immobilisation was continued for 3 weeks with serial radiographs done at week 1 and 2 to make sure the radial head was in reduced position. Elbow mobilisation was started after removal of the plaster under supervision of the physiotherapist. The patient was followed up at 3 and 6 months. At 6 months he had no residual pain at the elbow and movements were full elbow flexion & extension, full supination with restriction of last 10 degrees of pronation. There was no evidence of instability of the elbow.

Figure 1 Radiograph of the elbow showing a dislocated radial head. Full size image

Figure 2 Radiograph of the elbow showing a dislocated radial head. Full size image

Figure 3 Post reduction lateral radiograph of the elbow showing the radial head in reduced position. Full size image