[42] Elbow Dislocation Flashcards
Who do elbow dislocations usually occur in?
Young adults
What is an elbow dislocation classified as?
- Simple
- Complex
What is a complex elbow dislocation?
One associated with concomitant fracture
What % of elbow dislocations are posterior?
90%
What % of elbow dislocations suffer bony injury?
50%
What stabilises the elbow joint?
Static and dynamic stabilisers
What are the primary static stabilisers of the elbow?
- Humeroulnar joint
- Medial and collateral ligaments
What are the secondary static stabilisers or the elbow?
- Radiocapetellar joint
- Joint capsule
- Common flexor and extensor origin tendons
What are the dynamic stabilisers of the elbow?
- Surrounding musculature of elbow joint
- Aconeus
- Brachialis
- Triceps brachii
What can lead to ongoing instability in elbow dislocation?
If the elbows stabilising elements are damaged during traumatic dislocation and loss of all static stabilisation
What typically causes elbow dislocation?
High energy fall
How do patients with elbow dislocation present?
- Painful and deformed elbow
- Associated swelling and decreased function
What is important when examining a dislocation elbow?
Full neuromuscular examination of upper limb
Where is a nerve deficit often found in elbow dislocation?
In territory or ulnar nerve
What investigations may be done in elbow dislocation?
- X-ray
- CT
What x-ray views are required in elbow dislocations?
- AP
- Lateral
How can elbow dislocations be identified on x-ray?
Loss of radiocapitellar and ulnotrochlea congruence
I think this just means the elbow is out of its socket lmao
When is CT imaging useful in elbow dislocation?
Only in cases with associated fractures
What is the initial management of dislocated elbow?
Closed reduction
What are the basic methods for closed reduction of elbow dislocation?
- In line traction
- Manipulation of olecranon
What do you need to ensure when reducing dislocated elbow?
Sufficient analgesia +/- sedation if appropriate
What should be done once elbow has been reduced?
- Apply above-elbow backslab to keep elbow at 90 degrees
- Plain film radiograph to confirm reduction
- Re-assess neurovascular status
What is further management of elbow dislocation post-reduction dependant on?
Presence of associated fracture
How can simple elbow dislocation with no fracture be managed after reduction?
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.
When may operative fixation of elbow dislocation be required?
- Fracture
- Open type injury
- Neurovascular compromise
What is a common complication of elbow dislocation?
Early stiffness with loss of terminal extension
What is the most common neurovascular injury in elbow dislocation?
Stretching of the ulnar nerve
What long-term complication may arise with elbow dislocation?
Recurrent instability
What may be required with recurrent instability after elbow dislocation?
Future surgery
What is the terrible triad?
An elbow dislocation with;
- Lateral collateral ligament injury
- Radial head fracture
- Coronoid fracture
What does the terrible triad cause?
Very unstable elbow and poor outcome
What is the mechanism of injury causing the terrible triad?
Fall onto extended arm with rotation, resulting in posterolateral dislocation
What are patients likely to have long-term with terrible triad?
Recurrent problems with instability, stiffness, and arthrosis
What is the treatment for terrible triad?
Operative fixation of each of the components
