Last Updated on February 5, 2019 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.

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Elbow Dislocation