Difference between revisions of "Elbow dislocation"

(Text replacement - "==Diagnosis==" to "==Evaluation==")
(reduction techniques)
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==Clinical Features==
 
==Clinical Features==
*Elbow held in 45 degree of flexion; olecranon is prominent posteriorly
+
*Posterior dislocation
 +
**Elbow held in 45 degree of flexion; olecranon is prominent posteriorly
 +
*Anterior dislocation
 +
**Elbow held in extension
 
*Swelling may be severe
 
*Swelling may be severe
 
*Displaced equilateral triangle of olecranon and epicondyles (undisturbed in [[supracondylar fracture]])
 
*Displaced equilateral triangle of olecranon and epicondyles (undisturbed in [[supracondylar fracture]])
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**Lateral: both ulna and radius are displaced posteriorly
 
**Lateral: both ulna and radius are displaced posteriorly
 
**AP: lateral or medial displacement with ulna/radius in their normal relationship
 
**AP: lateral or medial displacement with ulna/radius in their normal relationship
 +
*Red flags
 +
**[[Compartment syndrome]]
 +
**Neurovascular injury
 +
**Open dislocations
  
 
==Management==
 
==Management==
*Reduce via longitudinal traction on wrist/forearm with downward pressure on forearm
+
*Likely require [[Procedural sedation]]
 +
*Reduction techniques: <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
 +
**Longitudinal traction on wrist/forearm with downward pressure on forearm
 +
**Patient lies prone
 +
***Assistant pulls counter traction on humerus
 +
***Provider pulls longitudinally with elbow in extension, then flexes elbow
 +
**Stimson
 +
***Patient prone with elbow flexed at 90 degrees at edge of bed. Hang weight from hand, and if needed provider can push olecranon into place
 
*Immobilize in [[Long_Arm_Posterior_Splint|long arm posterior mold]] with elbow in slightly less than 90deg flexion
 
*Immobilize in [[Long_Arm_Posterior_Splint|long arm posterior mold]] with elbow in slightly less than 90deg flexion
 +
**If unstable, splint with forearm in pronation
 +
**Document post reduction neurovascular status and post reduction films
  
 
==Disposition==
 
==Disposition==
*Obtain emergent consult for irreducible dislocations, nerve or vascular compromise, associated fracture
+
*Obtain emergent consult for irreducible dislocations, nerve or vascular compromise, associated fracture, open dislocation
 
*Simple dislocation requires ortho follow up within 1 week
 
*Simple dislocation requires ortho follow up within 1 week
  

Revision as of 23:54, 17 April 2017

Background

  • Usually due to FOOSH
  • 90% are posterolateral
  • Median and ulnar nerves may be injured
  • "Terrible Triad" injury describes unstable joint consisting of:

Clinical Features

  • Posterior dislocation
    • Elbow held in 45 degree of flexion; olecranon is prominent posteriorly
  • Anterior dislocation
    • Elbow held in extension
  • Swelling may be severe
  • Displaced equilateral triangle of olecranon and epicondyles (undisturbed in supracondylar fracture)

Differential Diagnosis

Elbow Diagnoses

Radiograph-Positive

Radiograph-Negative

Pediatric

Evaluation

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

Management

  • Likely require Procedural sedation
  • Reduction techniques: [1]
    • Longitudinal traction on wrist/forearm with downward pressure on forearm
    • Patient lies prone
      • Assistant pulls counter traction on humerus
      • Provider pulls longitudinally with elbow in extension, then flexes elbow
    • Stimson
      • Patient prone with elbow flexed at 90 degrees at edge of bed. Hang weight from hand, and if needed provider can push olecranon into place
  • Immobilize in long arm posterior mold with elbow in slightly less than 90deg flexion
    • If unstable, splint with forearm in pronation
    • Document post reduction neurovascular status and post reduction films

Disposition

  • Obtain emergent consult for irreducible dislocations, nerve or vascular compromise, associated fracture, open dislocation
  • Simple dislocation requires ortho follow up within 1 week

See Also

References

  1. Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.