Elbow Dislocation Flashcards
Epidemiology of elbow dislocations
Young adults (25% of injuries)
Classifications of dislocations
Simple vs complex
Complex = concomitant fracture
How do elbow dislocations usually displace?
90% occur posteriorly
50% suffering bone injury
What gives elbow joint stability?
Static = humeroulnar joint + medial and collateral ligaments
Radiocapetellar joint, joint capsule, common flexor and extensor origin tendons (minor)
Dynamic = Surrounding musculature of elbow joint (anconeus, brachialis, triceps brachii)
Are elbow dislocations common in children?
No they are rare.
A supracondylar type fracture should be suspected when a child has a deformed and painful elbow.
What happens to the stabilisers in traumatic dislocation?
They are damaged and there is loss of static stabilisation
This leads to ongoing instability
Mechanism of injury
Typically following a high-energy fall.
Clinical features
Painful and deformed joint.
Swelling + decreased function and can usually be near immobile.
The joint is usually in near full extension.
Disruption of equilateral triangle of elbow.

Examinations done in elbow dislocation
Joint examination + complete neurovascular examination of upper limb.
Upper and lower limb should also be examined.
Common nerve complications of dislocation
Ulnar nerve neuropraxia
Other neurovascular injury
Arterial injury of brachial artery.
However there is a good capillary refill still because of rich collateral circulation in elbow.
If there are any concerns over pulses Doppler USS should be done.
Ix of elbow dislocations
In significant trauma;
Resuscitation, investigation and management should be done per ATLS (advanced trauma life support) protocol.
For stable patients AP + lateral X-ray should be done.
CT imaging is only done if there is associated fractures.
X-ray findings.
Loss of radiocapitellar and ulnotrochlear congruence

Initial management of elbow dislocation.
Examination, documentation of neurovascular status
Analgesia +/- sedation
Closed reduction
Apply elbow backslab once reduced to keep elbow at 90 degrees
Explain closed reduction of elbow.
In line traction method (method 1)
Manipulation of the olecranon (method 2)
After this elbow can be flexed to 90 degrees to reassess the equilateral triangle of the elbow (which should be restored)
Apply elbow back slab to keep at 90 degrees
Plain film radiograph is required to confirm reduction
Reassess neurovascular status
Post-reduction management
Depends on associated fracture present.
Soft tissue damage -> LCL leads to elbow being stable in pronation.
MCL damage leads to elbow being stable in supination
Management post-reduction in simple elbow dislocation
With no fracture orthopaedic management can be done as outpatient with short period of immobilisation (5-14 days)
Early rehab with supervised range of motion exercises in stable arc can be introduced.
Management post-reduction if there is complicated dislocation;
e.g.
Fracture
Open type injury
Neurovascular compromise
Operative fixation can be considered such as ORIF of coronoid, radial head or olecranon with appropriate soft tissue repair of LCL and MCL
Complications of elbow dislocation
Early stiffness with loss of terminal extension. (Can be reduced by early tx and rehab)
Stretching of ulnar nerve
Brachial artery and median nerve injuries are rare.
Recurrent instability (although low recurrence rate <2%)
What is terrible triad?
Elbow dislocation with…
LCL injury
Radial head fracture
Coronoid fracture

Issues with Terrible triad
This combination causes an extremely unstable elbow.
Associated with a poor outcome.
Recurrent problems with instability, stiffness and arthrosis.
Mechanism of injury of terrible triad
Forces applied to join from fall onto an extend arm with rotation.
This leads to posterolateral dislocation (instead of posterior)
Management of terrible triad.
Operative fixation of each component
Radial head -> ORIF or arthroplasty
LCL reconstruction
Coronoid ORIF
MCL reconstruction is sometimes done at the same time