Elbow

Second most frequently dislocated joint (after the shoulder joint)

Sex: ♂ > ♀

Peak incidence: 10–20 years

Trauma

• Fall on an outstretched hand (most common) → posterior elbow dislocation

• A posterior, direct trauma to a flexed elbow → anterior elbow dislocation

• Medial/lateral trauma to the elbow → medial/lateral elbow dislocation

• High impact trauma to the elbow → divergent elbow dislocation

Anatomical classification

• Posterior dislocation (most common)

• Anterior dislocation

• Medial dislocation

• Lateral dislocation

• Divergent dislocations (rare)

Presence of co-existent fractures

• Simple dislocation

• Complex dislocation

Pain, swelling of the elbow

Limited range of motion: inability to flex or extend the elbow

Elbow deformity

Limb length discrepancy

Nerve injury (up to 10% of cases)

• Ulnar nerve palsy

• Median nerve palsy

• Radial nerve palsy or posterior interosseous neuropathy (depending on site of injury)

Brachial artery injury (very rare)

Physical examination

• Signs of fracture

• Neurovascular deficits

X-ray of the elbow joint: anteroposterior and lateral views to confirm dislocation and exclude fracture

• Posterior fat pad sign: seen in patients with concomitant fractures (usually of the humerus/radial head) [4]

• Radiocapitellar line

  • On a lateral x-ray of the elbow joint, an imaginary line drawn through the center of the neck of the radius should pass through the center of the capitellum of the humerus.

  • If an elbow dislocation is present, the line does not intersect the capitellum.

CT scan of the elbow joint: indicated only if a complex elbow dislocation is suspected to evaluate the extent of associated fractures

Conservative management

• Indication: simple elbow dislocation (no fracture)

• Procedure: closed reduction

• Signs of successful reduction

  • Return of the normal triangular orientation of the 3 bony prominences of the elbow

  • Decrease in pain

• Post-reduction x-rays are obtained

• Neurovascular status should be rechecked

• Immobilization of the relocated elbow in a posterior splint or brace, in pronation and 90° flexion for 7–10 days

Surgical intervention

• Indication: complex elbow dislocation (concomitant fracture); failed closed reduction; joint instability post-reduction; vascular injury

• Procedure

  1. Closed reduction of elbow

  2. Open reduction and internal fixation of the fractured segments and repair of the torn medial and/or lateral collateral ligaments of the elbow

• After surgery

  • Obtain elbow x-rays

  • Check neurovascular status of the forearm and hand

• Immobilization of the elbow in a posterior splint or brace in pronation and 90° flexion for 3 weeks [5]

Rehabilitation: range of motion exercises (active and passive)