Elbow dislocation: Difference between revisions
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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 | *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> | ||
** | **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 | **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:
- Elbow dislocation
- Radial head fracture
- 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
- Distal humerus fracture
- Radial head fracture
- Capitellum fracture
- Olecranon fracture
- Elbow dislocation
Radiograph-Negative
- Biceps tendon rupture/dislocation
- Lateral epicondylitis
- Medial epicondylitis
- Olecranon bursitis (nonseptic)
- Pronator teres syndrome
- Septic bursitis
Pediatric
- Nursemaid's elbow
- Supracondylar fracture
- Lateral epicondyle fracture
- Medial epicondyle fracture
- Olecranon fracture
- Radial head fracture
- Salter-Harris fractures
Evaluation
- 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 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
- To reduce dislocation:
- 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
- ↑ 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.