[42] Elbow Dislocation Flashcards

1
Q

Who do elbow dislocations usually occur in?

A

Young adults

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2
Q

What is an elbow dislocation classified as?

A
  • Simple

- Complex

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3
Q

What is a complex elbow dislocation?

A

One associated with concomitant fracture

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4
Q

What % of elbow dislocations are posterior?

A

90%

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5
Q

What % of elbow dislocations suffer bony injury?

A

50%

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6
Q

What stabilises the elbow joint?

A

Static and dynamic stabilisers

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7
Q

What are the primary static stabilisers of the elbow?

A
  • Humeroulnar joint

- Medial and collateral ligaments

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8
Q

What are the secondary static stabilisers or the elbow?

A
  • Radiocapetellar joint
  • Joint capsule
  • Common flexor and extensor origin tendons
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9
Q

What are the dynamic stabilisers of the elbow?

A
  • Surrounding musculature of elbow joint
  • Aconeus
  • Brachialis
  • Triceps brachii
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10
Q

What can lead to ongoing instability in elbow dislocation?

A

If the elbows stabilising elements are damaged during traumatic dislocation and loss of all static stabilisation

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11
Q

What typically causes elbow dislocation?

A

High energy fall

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12
Q

How do patients with elbow dislocation present?

A
  • Painful and deformed elbow

- Associated swelling and decreased function

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13
Q

What is important when examining a dislocation elbow?

A

Full neuromuscular examination of upper limb

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14
Q

Where is a nerve deficit often found in elbow dislocation?

A

In territory or ulnar nerve

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15
Q

What investigations may be done in elbow dislocation?

A
  • X-ray

- CT

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16
Q

What x-ray views are required in elbow dislocations?

A
  • AP

- Lateral

17
Q

How can elbow dislocations be identified on x-ray?

A

Loss of radiocapitellar and ulnotrochlea congruence

I think this just means the elbow is out of its socket lmao

18
Q

When is CT imaging useful in elbow dislocation?

A

Only in cases with associated fractures

19
Q

What is the initial management of dislocated elbow?

A

Closed reduction

20
Q

What are the basic methods for closed reduction of elbow dislocation?

A
  • In line traction

- Manipulation of olecranon

21
Q

What do you need to ensure when reducing dislocated elbow?

A

Sufficient analgesia +/- sedation if appropriate

22
Q

What should be done once elbow has been reduced?

A
  • Apply above-elbow backslab to keep elbow at 90 degrees
  • Plain film radiograph to confirm reduction
  • Re-assess neurovascular status
23
Q

What is further management of elbow dislocation post-reduction dependant on?

A

Presence of associated fracture

24
Q

How can simple elbow dislocation with no fracture be managed after reduction?

A

Outpatient followup, following with a short period of immobilisation (5-14 days, depending on local practice). Early rehabilitation with supervised range of motion exercises in the stable arc can be introduced.

25
When may operative fixation of elbow dislocation be required?
- Fracture - Open type injury - Neurovascular compromise
26
What is a common complication of elbow dislocation?
Early stiffness with loss of terminal extension
27
What is the most common neurovascular injury in elbow dislocation?
Stretching of the ulnar nerve
28
What long-term complication may arise with elbow dislocation?
Recurrent instability
29
What may be required with recurrent instability after elbow dislocation?
Future surgery
30
What is the terrible triad?
An elbow dislocation with; - Lateral collateral ligament injury - Radial head fracture - Coronoid fracture
31
What does the terrible triad cause?
Very unstable elbow and poor outcome
32
What is the mechanism of injury causing the terrible triad?
Fall onto extended arm with rotation, resulting in posterolateral dislocation
33
What are patients likely to have long-term with terrible triad?
Recurrent problems with instability, stiffness, and arthrosis
34
What is the treatment for terrible triad?
Operative fixation of each of the components