• Clinical science

Elbow dislocation (Dislocation of the elbow…)

Abstract

The elbow is the second most commonly dislocated joint after the shoulder. A fall on an outstretched hand is the usual mode of injury. Complex elbow dislocations have an associated fracture, while simple elbow dislocations do not. Clinical features include pain and swelling of the joint and an inability to flex/extend the elbow. Examination reveals a loss of the triangular orientation between the medial and lateral epicondyles of the humerus and the olecranon process of the ulna. X-rays of the elbow joint confirm a dislocation and may show a positive fat pad sign. Simple elbow dislocations can be managed conservatively with closed reduction and immobilization. Complex elbow dislocations require surgical intervention with open reduction and internal fixation. Complications of elbow dislocation include joint instability/contractures and heterotopic ossification.

Radial head subluxation is discussed in another learning card.

Epidemiology

  • Second most frequently dislocated joint (after the shoulder joint) Accounts for up to 25% of all elbow injuries
  • Sex: >
  • Peak incidence: 10–20 years

References:[1]

Epidemiological data refers to the US, unless otherwise specified.

Etiology

  • Trauma: typically from a fall with an outstretched hand
  • Specific mechanism of injury
    • Fall on an outstretched hand → 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

References:[2]

Classification

  • Anatomical classification
    • Posterior dislocation (most common: 90%)
    • Anterior dislocation
    • Medial dislocation
    • Lateral dislocation
    • Divergent dislocations (rare)
  • Presence of co-existent fractures
    • Simple dislocation (up to 60%)
    • Complex dislocation

References:[1][2]

Clinical features

References:[3][4][5][6][7]

Diagnostics

  • Physical examination
  • X-ray of the elbow joint
    • AP view and lateral view to confirm dislocation and exclude fracture
    • The direction of dislocation can be seen (posterior, anterior, etc.).
    • CT scan of the elbow joint: indicated only if a complex elbow dislocation is suspected to evaluate the extent of associated fractures

References:[1][2][8][9][10][11]

Treatment

  • 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
    • Postreduction x-rays are obtained
    • Neurovascular status should be re-checked
    • 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
    • Postoperative elbow x-rays are obtained
    • Postoperative neurovascular status of the forearm and hand are checked
    • Immobilization of the elbow in a posterior splint or bracein pronation and 90° flexion for 3 weeks
  • Rehabilitation: range of motion exercises (active and passive)

References:[5][12][13][14][15]

Complications

We list the most important complications. The selection is not exhaustive.