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

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

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:

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Elbow Dislocation