Elbow dislocation

Background

• Usually due to FOOSH
• 90% are posterolateral
• Median and ulnar nerves may be injured
• "Terrible Triad" injury describes unstable joint consisting of:
  1. Elbow dislocation
  2. Radial head fracture
  3. Coronoid fracture

Clinical Features

• Swelling may be severe
• Displaced equilateral triangle of olecranon and epicondyles (undisturbed in supracondylar fracture)

Posterior dislocation

• Elbow held in 45 degree of flexion
• Olecranon is prominent posteriorly

Anterior dislocation

• Elbow held in extension

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Radial head fracture
  • Essex-Lopresti fracture
• Capitellum fracture
• Olecranon fracture
• Elbow dislocation

Radiograph-Negative

• Lateral epicondylitis
• Medial epicondylitis
• Olecranon bursitis (nonseptic)
• Septic bursitis
• Biceps tendon rupture/dislocation

Pediatric

• Nursemaid's elbow
• Supracondylar fracture
• Lateral epicondyle fracture
• Medial epicondyle fracture
• Olecranon fracture
• Radial head fracture
• Salter-Harris fractures

Evaluation

Lateral view

AP view

• Imaging
  • Look for associated fractures (especially of coronoid and radial head)
  • Lateral: both ulna and radius are displaced posteriorly
  • AP: lateral or medial displacement with ulna/radius in their normal relationship
• Red flags
  • Compartment syndrome
  • Neurovascular injury
  • Open dislocations

Management

• Likely require Procedural sedation
• Reduction techniques:
  • Longitudinal traction on wrist/forearm with downward pressure on forearm
  • Patient lies prone
    • Assistant pulls counter traction on humerus
    • Provider pulls longitudinally with elbow in extension, then flexes elbow
  • Stimson
    • Patient prone with elbow flexed at 90 degrees at edge of bed. Hang weight from hand, and if needed provider can push olecranon into place
• Immobilize in long arm posterior mold with elbow in slightly less than 90deg flexion
  • If unstable, splint with forearm in pronation
  • Document post reduction neurovascular status and post reduction films

Disposition

• Obtain emergent consult for irreducible dislocations, nerve or vascular compromise, associated fracture, open dislocation
• Simple dislocation requires ortho follow up within 1 week

See Also

• Splinting
• LITFL Elbow Dislocation
• Reduction Videos

References

Authors

Jordan Swartz, Ted Fan, Manpreet Singh, Kian Preston-Suni, Kevin Lu, Ross Donaldson, Daniel Eggeman, Daniel Ostermayer, Neil Young