Elbow dislocation

Elbow dislocation is the second-most common joint dislocation after the shoulder. It generally occurs in the younger patient involving complex mechanisms. There is invariably disruption of the capsule and ligament stabilisers.

Classification

By position of the olecranon: posterolateral is by far the most common.

Simple: no associated fracture (50%).

Complex: associated fractures (50%), radial head and coronoid.

Epidemiology

Predominantly occurring in people 10–20 years of age, more likely related to mechanism, e.g. ski jumping, skateboarding or complex tackles in sport.

Presentation

Likely mechanism, obvious deformity and pain.

Examination should be done before and after reduction for:

• skin integrity
• neurovascular assessment, including radial pulse; capillary return to fingertips; and radial, median and ulnar nerve power sensation in the hand (particular risk of ulnar nerve and brachial artery injury).
• assessment for forearm compartment syndrome.

Imaging

Plain x-rays: AP and lateral.

CT scan: complex dislocations with fractures.

Management options

Simple stable dislocations: reduction and splinting 90 degrees for 7–10 days then mobilise under supervision. Alternative is hinged brace for 2–3 weeks.

All other complex or unstable dislocations: early referral to an orthopaedic doctor. Instability may be evident during the reduction process and the bone may not remain reduced; escalate if in doubt.

Skin integrity concerns, neurovascular issues or suspicion of compartment syndrome: immediate referral to an orthopaedic doctor or senior ED clinician. Clearly document findings. Urgent reduction may be indicated.

Referral and follow-up requirements

Simple: plaster of paris splint or hinged brace, and review by orthopaedic doctor after one week.

All other: refer to orthopaedic doctor in ED.

Neurovascular, skin or compartment compromise require immediate referral and action by senior ED clinician and orthopaedic doctor.

Potential complications

Immediate: ulnar and medial nerves, brachial artery injury, compartment syndrome.

Medium-term: varus posteromedial instability, loss of range of movement.

Long-term: contracture and stiffness, chronic instability, articular surface damage.

Patient advice

Pain from the fracture and restriction of movement is usual for 2–3 weeks and will require regular analgesia, then analgesia as required.

Resources

• Elbow dislocation
  Source: Orthobullets