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:
  • Elbow dislocation
  • Radial head fracture
  • Coronoid fracture

Clinical Features

• Elbow held in 45 degree of flexion; olecranon is prominent posteriorly
• Swelling may be severe

Diangosis

• Imaging
  • Look for associated fractures (esp of coronoid and radial head)
  • Lateral: both ulna and radius are displaced posteriorly
  • AP: lateral or medial displacement w/ ulna/radius in their normal relationship

Lateral view

AP view

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

• Distal humerus fracture
• Radial head fracture
  • Essex-Lopresti 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

Treatment

• Reduce via longitudinal traction on wrist/forearm w/ downward pressure on forearm
• Immobilize in long arm posterior mold w/ elbow in slightly less than 90deg flexion

Disposition

• Obtain emergent consult for irreducible dislocations, NV compromise, associated fx
• Simple dislocation requires ortho f/u within 1 week

See Also

• Splinting
• LITFL Elbow Dislocation
• Reduction Videos

Source

Tintinalli