Elbow dislocation
Updates to Article Attributes
Elbow dislocation is the second most common large joint dislocation in the adult population.
Terminology
A dislocation with no fracture is simple which only requires close reduction whereas an accompanying fracture makes the dislocation complex usually requiring surgical intervention. The most common fracture is a radial head fracture, although coronoid process fracture is also common. The terrible triad of the elbow is the combination of 1-3:
- posterior dislocation
- coronoid process fracture
- radial head fracture
Epidemiology
Elbow dislocations are common, and account for 10-25% of all elbow injuries in the adult population 1.
Pathology
Mechanism
Most elbow dislocations are closed and are most frequently posterior (sometimes posterolateral or posteromedial) although anterior, medial, lateral and divergent dislocations are also infrequently encountered). Posterior dislocations typically occur following a fall onto an extended arm, either with hyperextension or a posterolateral rotatory mechanism 1.
Radiographic features
In most cases, plain films suffice for assessment of elbow dislocations, although CT is increasingly used to pre-operatively assess intra-articular fractures.
Plain radiograph
The dislocation is usually obvious, especially if adequate AP and lateral views are obtained, however, the challenge is in identifying associated fractures.
Although rarely required in practice, a line drawn along the anterior margin of the humerus (anterior humeral line) and one along the long axis of the radius should intersect near the centre of the capitellum 3.
Report checklist
In addition to reporting the presence of a dislocation, a number of features should be sought and commented upon.
- dislocation direction
- posterior, posterolateral, posteromedial, lateral, medial or divergent
- associated fractures
- most frequently the radial head and coronoid process
- other fractures encountered include: lateral condyle, capitellum, olecranon 2
- wrist and shoulder may need to be imaged if there is clinical concern
Treatment and prognosis
When elbow dislocation is simple (i.e. no associated fracture) then closed reduction and a brief period (e.g. <2 weeks) of immobilisation at 90 degrees of flexion usually suffices 1,3.
Complex fracture-dislocations of the elbow require operative management, consisting reduction of the dislocation, management of the fracture and repair of surrounding damaged soft tissues (ORIF). They are far more likely to have a poor outcome, including secondary osteoarthritis, limited range of motion, instability and recurrent dislocation as well as pain 1.
Occasionally injury to the brachial artery may be seen (this is more common in open fracture-dislocations) 2.
-<p><strong>Elbow dislocation</strong> is the second most common <a href="/articles/large-joint-dislocation">large joint dislocation</a> in the adult population. </p><h4>Terminology</h4><p>A dislocation with no fracture is <em>simple </em>whereas an accompanying fracture makes the dislocation <em>complex</em>. The most common fracture is a <a href="/articles/radial-head-fractures">radial head fracture</a>, although <a href="/articles/coronoid-process-fracture">coronoid process fracture</a> is also common. The <a href="/articles/terrible-triad-of-the-elbow">terrible triad of the elbow</a> is the combination of <sup>1-3</sup>:</p><ul>- +<p><strong>Elbow dislocation</strong> is the second most common <a href="/articles/large-joint-dislocation">large joint dislocation</a> in the adult population. </p><h4>Terminology</h4><p>A dislocation with no fracture is simple which only requires close reduction whereas an accompanying fracture makes the dislocation <em>complex </em> usually requiring surgical intervention. The most common fracture is a <a href="/articles/radial-head-fractures">radial head fracture</a>, although <a href="/articles/coronoid-process-fracture">coronoid process fracture</a> is also common. The <a href="/articles/terrible-triad-of-the-elbow">terrible triad of the elbow</a> is the combination of <sup>1-3</sup>:</p><ul>
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