Elbow Dislocations

Last Updated on by FRCEM Intermediate

Elbow Dislocations

Dislocation Classification:

  • Simple vs complex:
    • Simple: dislocation
    • Complex: dislocation with fracture
  • Classify according to the direction of displacement of ulna relative to humerus
    Common- Posterior, posterolateral, rate- lateral, anterior

Evaluation

  • The mechanism of injury is usually a fall onto an outstretched hand.
  • Brachial Artery- more common with anterior and open dislocations
  • Median and ulnar nerve are most susceptible to damage

X-ray

  • AP and lateral X-Rays of the elbow should be examined to determine the direction of the dislocation and to identify any associated fractures.

Management in ED:

  • Emergent orthopedic consult for any patient with concern for vascular damage (loss of pulse), neurological deficits (loss of sensation, contractures) or open dislocation/fracture
  • Closed reduction:
    • lever the olecranon forward with both thumbs while holding the elbow flexed and while an assistant providesb traction on the forearm.
    • Flex the elbow to 60° with countertraction on the upper arm. Pull on the fully pronated forearm at this angle—slight flexion at the elbow may be necessary
  • Immobilize in long arm posterior splint with elbow in 90 degrees of flexion for 1-2 week with orthopedics follow up as outpatient within 1 week for repeat radiographs
  • Complex Dislocations:Most will need operative management

Pulled elbow

Overiew

  • A pulled elbow is a subluxation or partial dislocation of the radial head
  • annular ligament surrounding the radial head slips easily over the developing radial head and slides into the radio-humeral joint.

Evaluations

  • Pulled elbow usually occurs as a result of a sudden pulling motion in axial traction with the elbow extended.
  • Unwilling to use that arm, often held by the side pronated with slight elbow flexion.
  • Resistance and pain with any elbow or forearm movements
  • X-ray: Most cases can be diagnosed on clinical assessment alone and do not require imaging

Management

There are two manoeuvres that are described to reduce the radial head subluxation:

  • hyperpronation
  • the supination/flexion method.

Read:

Elbow Dislocation

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