II. Epidemiology

  1. Third most common joint dislocation (after Shoulders and fingers)

III. Causes

  1. Fall on Outstretched Hand with elbow hyperextended

IV. Pathophysiology

  1. Dislocation directions (ulna relative to Humerus)
    1. Posterior Elbow Dislocation (90%)
    2. Anterior Dislocation
    3. Pure lateral and medial dislocations (rare)

V. Exam

  1. In addition to elbow, evaluate Shoulder and wrist for concurrent injury
  2. Evaluate Hand Neurovascular Exam
    1. Evaluate radial pulse, distal coloration and Capillary Refill
    2. Evaluate median (ok sign), ulnar (finger abduction) and Radial Nerve (wrist dorsiflexion) function

VI. Signs

  1. Obvious elbow deformity
  2. Abnormal alignment of olecranon and both epicondyles
    1. Elbow flexed to 90 degrees
    2. Assess alignment of these 3 points at elbow
      1. Normal: equilateral triangle
      2. Dislocated: straight line
  3. Radial Head Fracture easy to feel at lateral epicondyle
    1. Vascular compromise unlikely if present

VII. Differential Diagnosis

  1. Supracondylar Fracture
  2. Medial Epicondyle avulsion Fracture
  3. Radial Head Fracture

VIII. Precautions: Emergent Orthopedic Consultation Indications (Complex Dislocation)

  1. Open Fracture
  2. Entrapped soft tissue and non-reducible dislocation

IX. Management: Reduction

  1. Anesthesia
    1. Consider pre-procedure analgesia
    2. Consider Joint Injection of Anesthetic
    3. Consider Procedural Sedation
  2. Background
    1. Posterior dislocation (90% of cases) reduction is desccribed
    2. Anterior reductions require reverse of pressure applied at olecranon (posterior)
  3. Parvin's Method (prone, often first maneuver)
    1. Position
      1. Patient prone on gurney
      2. Patient's arm abducted at Shoulder and flexed 90 degrees at elbow
      3. Elbow at edge of gurney and arm hanging loosely over the side with fingers pointing toward floor
    2. Technique 1
      1. Examiner grasps the patient's wrist, slightly supinates the Forearm, and applies downward traction at wrist
      2. Examiner, with other hand, applies downward pressure at olecranon process
        1. Also disengage the coronoid process from olecranon fossa by applying downward pressure
        2. May also gently extend elbow
    3. Technique 2 (if technique 1 fails)
      1. Place pillow under distal Humerus (just proximal to elbow)
      2. Attach 5-10 pound weight at the wrist and wait several minutes
    4. Completion
      1. Anticipate a "clunk" as the elbow relocates
      2. Confirm relocation with gentle range of motion
  4. Straight Traction (two person technique)
    1. Position
      1. Patient lies supine on gurney
      2. Patient's arm abducted at Shoulder
    2. Technique
      1. One examiner braces mid-shaft Humerus against gurney with both hands
        1. Applies downward force to olecranon
      2. Second examiner
        1. One hand grasps wrist, supinates Forearm and flexes elbow with downward traction
        2. Second hand applies inline traction at volar Forearm
    3. Completion
      1. Anticipate a "clunk" as the elbow relocates
      2. Confirm relocation with gentle range of motion

X. Management: Post-Reduction

  1. Obtain post-reduction XRay
  2. Evaluate Hand Neurovascular Exam after reduction
    1. See exam above
    2. Check gentle range of motion of elbow
  3. Immobilize elbow in molded posterior plaster or fiberglass splint
    1. Splint elbow at 90 degrees flexion
      1. Allows ligament and capsular healing
    2. Splint for 5-10 days (or until orthopedic or sports medicine follow-up)
  4. Gentle Range of motion after Splinting
    1. Never force range of motion (worsens injury)
    2. Temporary stiffness is common
  5. Discharge Instructions
    1. Ice on for 20 min/hour for first few days
    2. Elevation
    3. Sling with splint until follow-up
    4. Return immediately for numb, cold, pale or immobile hand
    5. Follow-up with orthopedics or sports medicine in next few days

XI. Prognosis

  1. Full elbow Range of motion may take months
  2. May have some residual restriction in range of motion
    1. Often minor restriction
    2. Does not interfere with function

XII. Complications

  1. Elbow Instability
  2. Brachial Artery Injury
  3. Median Nerve Injury
  4. Ulnar Nerve Injury

XIII. References

  1. Chapman (2019) Crit Dec Emerg Med 33(10):12-3
  2. Eiff (2018) Fracture Management for Primary Care, Elsevier, Philadelphia, p. 151-3

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Related Studies

Ontology: Dislocation of elbow joint (C2720437)

Concepts Injury or Poisoning (T037)
ICD9 832
ICD10 S53.1 , S53.10
SnomedCT 125617002, 157260003, 208810008, 417558002
English Dislocation of elbow NOS, Dislocation of elbow, unspecified, Elbow dislocations, Dislocations of the elbows, Traumatic dislocation of elbow joint, dislocation of elbow, dislocation of elbow (diagnosis), Elbow dislocation, dislocation of elbow (physical finding), Dislocation of other and unspecified parts of elbow, Dislocation;elbow, elbow dislocation, dislocated elbow, dislocated elbows, dislocation elbow, dislocate elbow, dislocations elbow, Dislocation of elbow NOS (disorder), Elbow luxation, traumatic dislocation of elbow, dislocation of elbow traumatic, traumatic dislocation of elbow (diagnosis), Dislocation of elbow, Dislocated elbow, Traumatic dislocation of elbow joint (disorder), dislocation; elbow, elbow; dislocation, Dislocation of elbow joint, Dislocation of elbow joint (disorder), dislocation of the elbow
Spanish luxación traumática de la articulación del codo, Luxación de codo, Luxación de la articulación del codo, luxación de codo, SAI (trastorno), luxación de codo, SAI, codo luxado, luxación del codo, luxación traumática de la articulación del codo (trastorno), luxación traumática del codo, luxación de la articulación del codo (trastorno), luxación de la articulación del codo
Dutch elleboogontwrichting, ontwrichte elleboog, elleboog; luxatie, luxatie; elleboog, Luxatie van elleboog, niet gespecificeerd
French Luxation du coude, Coude luxé, Luxation de l'articulation du coude
German Luxation des Ellbogengelenks, Luxation des Ellbogens, luxierter Ellbogen, Ellbogenluxation, Luxation des Ellenbogens, nicht naeher bezeichnet
Italian Lussazione del gomito, Gomito lussato, Lussazione di articolazione del gomito
Portuguese Luxação do cotovelo, Cotovelo luxado, Luxação da articulação do cotovelo
Japanese 肘関節脱臼, 肘の脱臼, ヒジノダッキュウ, ヒジカンセツダッキュウ, チュウカンセツダッキュウ
Czech Vymknutý loket, Vykloubení lokte, Vykloubení loketního kloubu, Vymknutí lokte
Korean 상세불명의 팔꿈치의 탈구
Hungarian Luxált könyökízület, Luxatio cubiti, Könyökízület luxatiója, Könyökficam