Elbow Dislocation Management in the ED Clinical Presentation

Updated: Jan 27, 2022
  • Author: James E Keany, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Presentation

History

Obtain patient history that includes mechanism of injury, type and location of pain, amount of immediate dysfunction, treatment prior to arrival in the ED, timing of the appearance of effusion, and history of prior elbow injury:

  • Mechanisms: A fall onto an extended, abducted arm (posterior) or a direct blow to a flexed elbow (anterior)

  • Pain: Intense, focused at the elbow joint

  • Dysfunction: Extremely limited range of motion

  • Effusion: Posterior fat pad displaced dorsally and superiorly by joint fluid

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Physical

In posterior dislocations, the elbow is flexed, with an exaggerated prominence of the olecranon. On palpation, the olecranon is displaced from the plane of the epicondyles (as opposed to a supracondylar fracture, in which the epicondyles are palpable in the same plane as the olecranon).

In anterior dislocations, the elbow is held in full extension. The upper arm appears shortened, and the forearm is elongated and is held in supination.

Neurovascular function should be documented in detail before and after reduction. Continued repeated examination is essential.

Indications for admission with frequent neurovascular assessment include the following:

  • Pediatric patients
  • Unreliable patients
  • Presence of extensive edema
  • Evidence of neurovascular compromise before or after reduction
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Complications

Complications of elbow dislocation may include the following:

  • Brachial artery injury [8]

  • Medial nerve injury

  • Ulnar nerve injury

  • Concomitant fractures

  • Avulsion of the triceps mechanism insertion (anterior dislocation only)

  • Entrapment of bone fragments within the joint space

  • Joint stiffness with decreased range of motion (particularly in extension)

  • Myositis ossificans

  • Compartment syndrome

Treatment of complex elbow dislocation fractures is a challenge for both the treating surgeon and the patient because of the complex bony and soft tissue anatomy of the joint. To establish an expedient treatment algorithm, the clinician must thoroughly assess all osseous and ligamentous injuries. [9]   

Unnecessary delay in treatment of this complex injury can result in posttraumatic functional disorders, recurrent instability, and secondary arthrosis. Goals of surgical treatment must include correct restoration of joint anatomy and stability as prerequisites for successful treatment of elbow fracture/dislocation to enable early motion of the joint. [9]  

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