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- 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
- 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
- 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
- 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.
- 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
There are two manoeuvres that are described to reduce the radial head subluxation:
- the supination/flexion method.