Elbow dislocation: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Elbow held in 45 degree of flexion; olecranon is prominent posteriorly | *Posterior dislocation | ||
**Elbow held in 45 degree of flexion; olecranon is prominent posteriorly | |||
*Anterior dislocation | |||
**Elbow held in extension | |||
*Swelling may be severe | *Swelling may be severe | ||
*Displaced equilateral triangle of olecranon and epicondyles (undisturbed in [[supracondylar fracture]]) | *Displaced equilateral triangle of olecranon and epicondyles (undisturbed in [[supracondylar fracture]]) | ||
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**Lateral: both ulna and radius are displaced posteriorly | **Lateral: both ulna and radius are displaced posteriorly | ||
**AP: lateral or medial displacement with ulna/radius in their normal relationship | **AP: lateral or medial displacement with ulna/radius in their normal relationship | ||
*Red flags | |||
**[[Compartment syndrome]] | |||
**Neurovascular injury | |||
**Open dislocations | |||
==Management== | ==Management== | ||
* | *Likely require [[Procedural sedation]] | ||
*Reduction techniques: <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | |||
**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_Splint|long arm posterior mold]] with elbow in slightly less than 90deg flexion | *Immobilize in [[Long_Arm_Posterior_Splint|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== | ==Disposition== | ||
*Obtain emergent consult for irreducible dislocations, nerve or vascular compromise, associated fracture | *Obtain emergent consult for irreducible dislocations, nerve or vascular compromise, associated fracture, open dislocation | ||
*Simple dislocation requires ortho follow up within 1 week | *Simple dislocation requires ortho follow up within 1 week | ||
Revision as of 23:54, 17 April 2017
Background
- Usually due to FOOSH
- 90% are posterolateral
- Median and ulnar nerves may be injured
- "Terrible Triad" injury describes unstable joint consisting of:
- Elbow dislocation
- Radial head fracture
- Coronoid fracture
Clinical Features
- Posterior dislocation
- Elbow held in 45 degree of flexion; olecranon is prominent posteriorly
- Anterior dislocation
- Elbow held in extension
- Swelling may be severe
- Displaced equilateral triangle of olecranon and epicondyles (undisturbed in supracondylar fracture)
Differential Diagnosis
Elbow Diagnoses
Radiograph-Positive
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
- 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: [1]
- 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
References
- ↑ Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.