Difference between revisions of "Elbow dislocation"

(Text replacement - "==Diagnosis==" to "==Evaluation==")
(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
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*#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]])
 
*Displaced equilateral triangle of olecranon and epicondyles (undisturbed in [[supracondylar fracture]])
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 +
===Posterior dislocation===
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*Elbow held in 45 degree of flexion
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*Olecranon is prominent posteriorly
 +
 +
===Anterior dislocation===
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*Elbow held in extension
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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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
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**[[Compartment syndrome]]
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**Neurovascular injury
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**Open dislocations
  
 
==Management==
 
==Management==
*Reduce via longitudinal traction on wrist/forearm with downward pressure on forearm
+
*Likely requires [[procedural sedation]]
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*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>
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**Longitudinal traction on wrist/forearm with downward pressure on forearm
 +
**Patient lies prone
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***Assistant pulls counter traction on humerus
 +
***Provider pulls longitudinally with elbow in extension, then flexes elbow
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**Stimson
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***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
  
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==References==
 
==References==
 
+
<references/>
 
[[Category:Orthopedics]]
 
[[Category:Orthopedics]]

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.