Difference between revisions of "Elbow dislocation"

(Management)
 
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*Median and ulnar nerves may be injured
 
*Median and ulnar nerves may be injured
 
*"Terrible Triad" injury describes unstable joint consisting of:
 
*"Terrible Triad" injury describes unstable joint consisting of:
**Elbow dislocation
+
*#Elbow dislocation
**Radial head fracture
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*#[[Radial head fracture]]
**Coronoid fracture
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*#Coronoid fracture
  
 
==Clinical Features==
 
==Clinical Features==
*Elbow held in 45 degree of flexion; olecranon is prominent posteriorly
 
 
*Swelling may be severe
 
*Swelling may be severe
 +
*Displaced equilateral triangle of olecranon and epicondyles (undisturbed in [[supracondylar fracture]])
  
==Diangosis==
+
===Posterior dislocation===
*Imaging
+
*Elbow held in 45 degree of flexion
**Look for associated fractures (esp of coronoid and radial head)
+
*Olecranon is prominent posteriorly
**Lateral: both ulna and radius are displaced posteriorly
+
 
**AP: lateral or medial displacement w/ ulna/radius in their normal relationship
+
===Anterior dislocation===
 +
*Elbow held in extension
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Elbow DDX}}
 
{{Elbow DDX}}
  
==Treatment==
+
==Evaluation==
*Reduce via longitudinal traction on wrist/forearm w/ downward pressure on forearm
+
[[File:Elbow dislocation lateral.jpg|thumb|Lateral view]]
*Immobilize in [[Long_Arm_Posterior_Splint|long arm posterior mold]] w/ elbow in slightly less than 90deg flexion
+
[[File:Elbow dislocation AP.jpg|thumb|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
 +
**[[Compartment syndrome]]
 +
**Neurovascular injury
 +
**Open dislocations
 +
 
 +
==Management==
 +
*Likely requires [[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
 +
**If unstable, splint with forearm in pronation
 +
**Document post reduction neurovascular status and post reduction films
  
 
==Disposition==
 
==Disposition==
*Obtain emergent consult for irreducible dislocations, NV compromise, associated fx
+
*Obtain emergent consult for irreducible dislocations, nerve or vascular compromise, associated fracture, open dislocation
*Simple dislocation requires ortho f/u within 1 week
+
*Simple dislocation requires ortho follow up within 1 week
  
 
==See Also==
 
==See Also==
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*[http://www.youtube.com/watch?v=vdrfY3K7yR4 Reduction Videos]
 
*[http://www.youtube.com/watch?v=vdrfY3K7yR4 Reduction Videos]
  
==Source==
+
==References==
Tintinalli
+
<references/>
 
+
[[Category:Orthopedics]]
[[Category:Ortho]]
 

Latest revision as of 07:32, 17 May 2019

Background

  • Usually due to FOOSH
  • 90% are posterolateral
  • Median and ulnar nerves may be injured
  • "Terrible Triad" injury describes unstable joint consisting of:
    1. Elbow dislocation
    2. Radial head fracture
    3. Coronoid fracture

Clinical Features

  • Swelling may be severe
  • Displaced equilateral triangle of olecranon and epicondyles (undisturbed in supracondylar fracture)

Posterior dislocation

  • Elbow held in 45 degree of flexion
  • Olecranon is prominent posteriorly

Anterior dislocation

  • Elbow held in extension

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 requires 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.