Recommended Modifications to Your Poster — Referenced from Rockwood & Green's Fractures in Adults, 10th ed. (2025) & Miller's Review of Orthopaedics, 9th ed.

1. Introduction — Strengthen the Definition & Classification

• Specify the direction: posterior dislocation is the most common type (>90% of elbow dislocations)
• Add epidemiology: "The elbow is the second most commonly dislocated major joint in adults, with a reported rate of 5.2 per 100,000 person-years" — Rockwood & Green's, p. 1648
• Mention the Tossy/O'Driscoll classification of ligament disruption sequence: lateral → capsule → medial (LCL fails first, MCL last)

2. Examination — Add the Classic Triad of Bony Landmarks

"In a posterior dislocation, the posterior prominence of the olecranon disrupts the normal equilateral triangle relationship formed by the medial epicondyle, lateral epicondyle, and the tip of the olecranon." — Rockwood & Green's, Simple Elbow Dislocation chapter

3. Treatment — This is Your Most Important Section to Expand

A. Surgical Indication (currently missing)

"The main indication for operative management of simple elbow dislocations is an inability to maintain a concentric elbow joint after closed reduction or a recurrent dislocation. Chronic or missed dislocations are an uncommon but important indication for surgery."

B. Surgical Approach — Be Specific

"More recent experience suggests the triceps should be preserved — both to improve motion and to provide stability postoperatively. A combined medial and lateral approach without violating the extensor mechanism is preferred."

C. Soft Tissue Release Steps (add specifics)

"The ulnar nerve was mobilized and the flexor and extensor origins and collateral ligaments detached from the distal humerus as a sleeve to gain exposure. Scar tissue and heterotopic ossification were excised."

• Ulnar nerve identification and transposition (you did this — confirm it's listed)
• Capsulotomy / excision of fibrous scar and heterotopic ossification
• Articular cartilage assessment

D. Bell-Tawse Procedure — Add the Technical Description

"A strip of triceps tendon is turned down, left attached to the ulna, passed around the neck of the radius from behind forward, and secured through a drill hole in the ulna." (Bell-Tawse, 1965 — original technique)

E. UCL (Tommy John) Repair — Clarify Terminology

• Medial ulnar collateral ligament (MCL/UCL) = primary restraint to valgus stress
• Lateral ulnar collateral ligament (LUCL) = primary restraint to varus and posterolateral rotational stress

4. Discussion — Add Key Pathomechanics

• Ligament failure sequence: O'Driscoll's "circle of injury" — disruption progresses from lateral to medial. In chronic cases, both MCL and LCL are non-functional, which is why dual reconstruction is required.
• Why closed reduction fails in chronic cases: Fibrosis, capsular contracture, and bony changes prevent concentric joint restoration — supported by Rockwood & Green's and the Jupiter & Ring series (5 cases, all requiring open reduction at mean 11 weeks).
• Hinged external fixator: The standard Jupiter & Ring protocol used hinged external fixation for 4–6 weeks post-op in all patients. Mention why you chose not to use one (or add it if it was used). This is an important technical decision.
• Heterotopic ossification: Mention it as a key risk in chronic cases — prophylaxis with indomethacin or radiation can be considered.

5. References — Add Standard Orthopedic Textbook Sources

1. Rockwood and Green's Fractures in Adults, 10th ed. 2025 — Chapter on Simple Elbow Dislocation (the gold-standard reference for this procedure)
2. Jupiter JB, Ring D. Treatment of unreduced elbow dislocations with articular reconstruction. J Bone Joint Surg Am. 2002;84-A(9):1561–1570.
3. O'Driscoll SW. Elbow dislocations. In: Morrey BF, ed. The Elbow and Its Disorders, 3rd ed. Saunders; 2000.
4. Miller's Review of Orthopaedics, 9th ed. — LUCL/MCL anatomy and posterolateral rotatory instability

6. Conclusion — Tighten the Clinical Message

"Neglected posterior elbow dislocation, even at 3 months, is not a surgical lost cause. Open reduction with annular ligament reconstruction and UCL repair, combined with early physiotherapy, can restore functional range of motion and joint stability. Surgeon familiarity with the anatomy of both the medial and lateral collateral ligament complexes is critical to achieving a stable, functional reconstruction."

Summary Table of Modifications