Difference between revisions of "Elbow dislocation"

(Text replacement - "==References== " to "==References== <references/> ")
(Evaluation)
 
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*90% are posterolateral
 
*90% are posterolateral
 
*Median and ulnar nerves may be injured
 
*Median and ulnar nerves may be injured
 +
*Brachial artery may be injured
 
*"Terrible Triad" injury describes unstable joint consisting of:
 
*"Terrible Triad" injury describes unstable joint consisting of:
 
*#Elbow dislocation
 
*#Elbow dislocation
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==Evaluation==
 
==Evaluation==
[[File:Elbow dislocation lateral.jpg|thumb|Lateral view]]
+
[[File:Elbow dislocation lateral.jpg|thumb|Lateral view of posterior dislocation]]
[[File:Elbow dislocation AP.jpg|thumb|AP view]]
+
[[File:Elbow dislocation AP.jpg|thumb|AP view of posterior dislocation]]
 
*Imaging
 
*Imaging
 
**Look for associated fractures (especially of coronoid and radial head)
 
**Look for associated fractures (especially of coronoid and radial head)
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**[[Compartment syndrome]]
 
**[[Compartment syndrome]]
 
**Neurovascular injury
 
**Neurovascular injury
**Open dislocations  
+
**Open dislocations
  
 
==Management==
 
==Management==
*Likely require [[Procedural sedation]]
+
*Likely requires [[procedural sedation]] and/or intra-articular analgesic injection
 
*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>
 
*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
+
**To reduce dislocation:
**Patient lies prone
+
***an assistant should stabilize the humerus in 30 degrees of flexion, supinated and apply countertraction
***Assistant pulls counter traction on humerus
+
***provider applies traction to the supinated distal forearm
***Provider pulls longitudinally with elbow in extension, then flexes elbow
+
***following reduction, patients should be immobilized in a posterior splint with orthopedic follow-up in 1 week 
 
**Stimson
 
**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
 
***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

Latest revision as of 21:08, 22 October 2019

Background

  • Usually due to FOOSH
  • 90% are posterolateral
  • Median and ulnar nerves may be injured
  • Brachial artery 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 of posterior dislocation
AP view of posterior dislocation
  • 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 and/or intra-articular analgesic injection
  • Reduction techniques: [1]
    • To reduce dislocation:
      • an assistant should stabilize the humerus in 30 degrees of flexion, supinated and apply countertraction
      • provider applies traction to the supinated distal forearm
      • following reduction, patients should be immobilized in a posterior splint with orthopedic follow-up in 1 week
    • 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.