Surgical Treatment of Neglected Elbow Dislocation with the Box-loop Technique: A Case Report

The elbow is the second most common joint involved in dislocations in the human body, accounting for approximately 20% of all joint dislocations. The precariousness of some health services, in rural and less developed places, contributes to a higher rate of underdiagnosis of these injuries, resulting in a higher prevalence of persistent elbow dislocations. In the surgical management of chronic elbow dislocations, primary ligament repair is frequently not feasible, making reconstruction of the lateral and medial collateral ligament complexes of the elbow usually necessary, often with the use of grafts.

On October 07, 2023, a 39-year-old male patient presented to the emergency department of an external health service after falling from a flight of stairs. A fracture of his left distal radius was then diagnosed, and he underwent fixation of such a fracture with Kirschner wires, which evolved with a good clinical result. Five months later, in March/2024, the patient came to our health service and was also found to have a previously undiagnosed persistent left elbow dislocation. The case was operated on 1 month after, in April/2024, 6 months after the index trauma. On April 09, 2024, a surgical procedure was performed, with capsular release by lateral and medial incisions, open reduction of the joint, and reconstruction of the lateral and medial ligament complexes with an autologous graft (semitendinosus and gracilis tendons, harvested from the left thigh), using the box-loop technique. Since the procedure, the patient remains in regular clinical follow-up, presenting total joint congruency and functional arc of movement, despite signs of moderate ulno-humeral osteoarthritis. He is now able to perform his everyday activities without pain or any other symptoms.

This case is a report of a previously undiagnosed chronic elbow dislocation, which required a technique to reduce it and provide further elbow stability. The use of the box-loop technique proved effective in treating this patient, with good functional results.