38. Elbow Dislocation

Case 38


History and Physical Examination


A 19-year-old college basketball player presents to the emergency room 90 minutes after falling onto his extended arm. He complains of pain, swelling, and lack of motion of his elbow. He denies any numbness.


The patient demonstrates an obvious deformity of the elbow. His olecranon process appears prominent, and his range of motion is from 70 to 85 degrees. He has limited pronation and supination. Neurovascular examinations demonstrate a 2+ radial pulse, a 2+ ulnar pulse, and normal median, ulnar, and radial nerve function.


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Figure 38–1. (A,B) Anteroposterior (AP) radiographs of the elbow.


Differential Diagnosis


1. Distal humerus fracture


2. Posterior elbow dislocation


3. Olecranon fracture


Radiologic Findings


Anteroposterior (AP) radiographs are obtained (Fig. 38–1).



Diagnosis


Posterior Elbow Dislocation. Posterior elbow dislocation is suspected based on the clinical examination and the mechanism of injury. Radiographs confirm the diagnosis. No associated fracture of the radial head or coronoid process is appreciated. Also, the patient is neurovascularly intact. Treatment centers around an attempt at closed reduction of the posterior elbow dislocation. A thorough neurovascular examination should be performed prior to any attempt at reduction, not only to document abnormalities but also to assure that the reduction itself does not cause injury to the neurovascular structures.


Many techniques of manipulation have been described for closed reduction of posterior elbow dislocations. Most employ a combination of longitudinal traction and mild distraction. Options include placing the patient prone on a stretcher, after which time 5 to 10 lb of weight is applied to the wrist. Another alternative is having the patient drape his arm over the back of a chair and apply weights in a similar fashion. Usually, 10 to 15 minutes of traction will either result in spontaneous reduction or easy reduction with gentle longitudinal traction and mild distraction (Fig. 38–2). This technique was applied in the present patient with a concentric reduction confirmed radiographically. Careful neurovascular examination should be performed after reduction to assure no deterioration in neurovascular function. Also, elbow range of motion should be assessed and stability assured through a range of motion. If marked valgus or postero-lateral rotatory instability is appreciated, postreduction restrictions may be required.


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Figure 38–2. Closed reduction can generally be accomplished by applying downward longitudinal force with the patient prone. A gentle distracting force at the ulnohumeral articulation is sometimes required.


Surgical Management


Jan 28, 2017 | Posted by in ORTHOPEDIC | Comments Off on 38. Elbow Dislocation
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