Elbow dislocation

Contents

third most common joint dislocation after shoulder and petella
most commonly occurs in young people (5-25 years) in sporting events or high speed MVAs, dislocation of ulna
described according to the position of the distal segment (ulna) in relation to the proximal segment (humerus)
- 90% are posterior/posterolate
collateral ligaments disrupted, especially the lateral collateral ligament

Mechanism

elbow hyperextension via FOOSH or valgus/supination stress during elbow flexion

Clinical Features

elbow pain, swelling, deformity
flexion contracture
± absent radial or ulnar pulses

Terrible Triad of the Elbow
Radial head fracture Coronoid fracture Elbow dislocation

Treatment

closed reduction under anesthesia (post-reduction XRs required)
- gentle traction applied to the forearm with countertraction applied to the distal aspect of the humerus with the pt. in either the supine or prone position
long-arm splint with forearm in neutral rotation and elbow in 90 degree flexion
early ROM (<2 weeks)

PEARL

Assessment of neurovascular status is critical before and after reduction. This includes the radial, median and ulnar nerves and the brachial, radial and ulnar arteries

Complications

stiffness (loss of extension), intra-articular loose body, neurovascular injury (ulnar nerve, median nerve, brachial artery), heterotopic bone formation, radial head fracture

These injuries are surprisingly common considering the stability of the elbow joint. Despite the somewhat worrying appearance of the patient, the elbow and the X-ray, these are fairly simple to treat.

Clinical

Usually a male age 10-30 involved in sports with a fall onto an outstretched arm.
Check the neurovascular status before any reduction attempt.
Look for other injuries in the wrist, forearm and shoulder.
Check for any open wound.

X-Ray

Determine the direction of the dislocation (usually posterior as defined by the distal unit.)
Look carefully for associated fractures – radial head, olecranon, coronoid

Treatment

Sedate with fentanyl/versed cocktail
Apply traction by one of the methods shown below
Once reduced place thru a range of motion and determine stability then immobilize in an above elbow backslab and re-Xray. Note: Ensure joint is concentrically reduced in all views and recheck for #
Return to clinic in 1 week if reduced. If not then plan to admit for closed/open reduction in OR