Elbow dislocation
Revision as of 10:25, 7 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Treatment==" to "==Management==")
Background
- Usually due to FOOSH
- 90% are posterolateral
- Median and ulnar nerves may be injured
- "Terrible Triad" injury describes unstable joint consisting of:
- Elbow dislocation
- Radial head fracture
- Coronoid fracture
Clinical Features
- Elbow held in 45 degree of flexion; olecranon is prominent posteriorly
- Swelling may be severe
- Displaced equilateral triangle of olecranon and epicondyles (undisturbed in supracondylar fracture)
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
Diagnosis
- 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
Management
- Reduce via longitudinal traction on wrist/forearm with downward pressure on forearm
- Immobilize in long arm posterior mold with elbow in slightly less than 90deg flexion
Disposition
- Obtain emergent consult for irreducible dislocations, nerve or vascular compromise, associated fracture
- Simple dislocation requires ortho follow up within 1 week