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
**Radial head fracture
*#[[Radial head fracture]]
**Coronoid fracture
*#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 of posterior dislocation]]
*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 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
**[[Compartment syndrome]]
**Neurovascular injury
**Open dislocations
 
==Management==
*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>
**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_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==
*[[Splinting]]
*[http://lifeinthefastlane.com/elbow-dislocation/ LITFL Elbow Dislocation]
*[http://lifeinthefastlane.com/elbow-dislocation/ LITFL Elbow Dislocation]
*[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 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.