Elbow dislocation

Question 1

Two types elbow dislocation

Answer 1

• Simple
• Complex - concomitant fracture

Question 2

Most common direction of elbow dislocation

Answer 2

• 90% posterior
• 50% get associated bony injury

Question 3

Elbow joint stability - how?

Answer 3

• Primary static stabilisers - humeroulnar joint, medial and collateral ligaments
• Secondary static - radiocapitulum joint, capsule, common flexor and extensor origin tendons

Question 4

What happens to elbow stabilising elements during dislocation?

Answer 4

• Damaged if traumatic dislocation
• Loss of all static stabilisation
• = ongoing instability

Question 5

Clinical features elbow dislocation

Answer 5

• High energy fall
• Painful and deformed elbiw
• Swelling and decreased function

Question 6

NV exam for elbow dislocation - what are the findings often

Answer 6

• Deficit often found in ulnar nerve territory - common nerve injury
• Good capillary refill can be found even if arterial injury - elbow has rich collateral circulation

Question 7

X-ray findings of elbow dislocation

Answer 7

• Loss of radiocapitellar and ulnotrochlea congruence
• Anterior humeral line and radiocapitellar line help to identify

Question 8

Management elbow dislocation

Answer 8

• Closed reduction
• Sufficient analgesia +/- sedation
• Then above elbow backslab at 90 degrees

Question 9

Methods for closed reduction of elbow dislocation

Answer 9

• In line traction OR
• Manipulation of olecranon

Question 10

Management post reduction elbow dislocation - simple elbow

Answer 10

• Position of arm dependent on soft tissue damage - if medial collateral ligament damaged, more secure supinated and vice versa
• If simple: Immobilise and review 5-14 days as outpatient
• Early rehab

THINK pronator teres comes from medial epicondyle, if damaged, weak

Question 11

Management post reduction of complicated elbow dislocation

Answer 11

• If #, open injury or NV compromise - operative fixation
• ORIF with soft tissue repair

Question 12

Complications elbwo dislocation

Answer 12

• Stiffness - loss of terminal extension - early rehab and treatment reduce risk
• Stretching of ulnar nerve
• Recurrent instability

Question 13

What is terrible triad?

Answer 13

Elbow dislocation +:
* Lateral collateral ligament injury
* Radial head #
* Coronoid fracture

Question 14

Why is terrible triad bad? How do we fix it?

Answer 14

• very unstable elbow
• Associated with poor outcomes
• Recurrent instability problems
• Radial head and coronoid process ORIF with LCL reconstruction