Elbow dislocation: Difference between revisions
(reduction techniques) |
No edit summary |
||
| Line 4: | Line 4: | ||
*Median and ulnar nerves may be injured | *Median and ulnar nerves may be injured | ||
*"Terrible Triad" injury describes unstable joint consisting of: | *"Terrible Triad" injury describes unstable joint consisting of: | ||
* | *#Elbow dislocation | ||
* | *#[[Radial head fracture]] | ||
* | *#Coronoid fracture | ||
==Clinical Features== | ==Clinical Features== | ||
*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]]) | ||
===Posterior dislocation=== | |||
*Elbow held in 45 degree of flexion | |||
*Olecranon is prominent posteriorly | |||
===Anterior dislocation=== | |||
*Elbow held in extension | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 13:17, 27 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
- 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
- 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.