Most elbow dislocations are posterior and usually result from a fall on an extended arm.
Posterior elbow dislocations are common; it is the 2nd most common joint dislocation after shoulder dislocations. Associated injuries may include
Fractures
Injuries to the ulnar or median nerve
Possibly injury to the brachial artery
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The joint is usually flexed about 45°, and the olecranon is prominent and posterior to the humeral epicondyles; however, these anatomic relationships may be difficult to determine because of swelling. Classically, patients with an elbow dislocation present with a shortened forearm and a very prominent olecranon.
X-rays are diagnostic.
(See Overview of Dislocations.)
Treatment of Elbow Dislocations
Traction to reduce the elbow joint, usually with procedural sedation
For elbow dislocations, reduction is usually with sustained, gentle traction and correction of deformity after patients are sedated and given analgesics (see How To Reduce a Posterior Elbow Dislocation). The following technique is commonly used:
With the patient supine, the practitioner flexes the elbow to about 90° and supinates the forearm.
An assistant stabilizes the upper arm against the stretcher.
The practitioner grasps the wrist and applies slow, steady axial traction to the forearm while keeping the elbow flexed and the forearm supinated.
Traction is maintained until the dislocation is reduced.
After reduction, the practitioner checks the elbow for stability by fully flexing and extending the elbow while pronating and supinating the forearm. These movements should be easy after reduction. After reduction, an x-ray should be taken to make sure no fractures were missed.
The joint is immobilized. If the joint is stable, immobilization is with a sling, and range-of-motion exercises begin 1 week later. If the joint has laxity, immobilization is with a splint; the patient follows up with an orthopedic surgeon, who determines further management, including when to begin range-of-motion exercises.
Key Points
Many patients with an elbow dislocation present with a shortened forearm and a very prominent olecranon; the position of the bones may be difficult to determine because of swelling.
Take x-rays to diagnose a dislocated elbow.
Apply gentle, sustained traction to reduce the joint after patients are sedated and given analgesics.
After reduction, check the joint for stability, take x-rays to check for fractures, and immobilize the joint, especially if laxity is present.
