[42] Elbow Dislocation

Question 1

Who do elbow dislocations usually occur in?

Answer 1

Young adults

Question 2

What is an elbow dislocation classified as?

Answer 2

• Simple

- Complex

Question 3

What is a complex elbow dislocation?

Answer 3

One associated with concomitant fracture

Question 4

What % of elbow dislocations are posterior?

Answer 4

90%

Question 5

What % of elbow dislocations suffer bony injury?

Answer 5

50%

Question 6

What stabilises the elbow joint?

Answer 6

Static and dynamic stabilisers

Question 7

What are the primary static stabilisers of the elbow?

Answer 7

• Humeroulnar joint

- Medial and collateral ligaments

Question 8

What are the secondary static stabilisers or the elbow?

Answer 8

• Radiocapetellar joint
• Joint capsule
• Common flexor and extensor origin tendons

Question 9

What are the dynamic stabilisers of the elbow?

Answer 9

• Surrounding musculature of elbow joint
• Aconeus
• Brachialis
• Triceps brachii

Question 10

What can lead to ongoing instability in elbow dislocation?

Answer 10

If the elbows stabilising elements are damaged during traumatic dislocation and loss of all static stabilisation

Question 11

What typically causes elbow dislocation?

Answer 11

High energy fall

Question 12

How do patients with elbow dislocation present?

Answer 12

• Painful and deformed elbow

- Associated swelling and decreased function

Question 13

What is important when examining a dislocation elbow?

Answer 13

Full neuromuscular examination of upper limb

Question 14

Where is a nerve deficit often found in elbow dislocation?

Answer 14

In territory or ulnar nerve

Question 15

What investigations may be done in elbow dislocation?

Answer 15

• X-ray

- CT

Question 16

What x-ray views are required in elbow dislocations?

Answer 16

• AP

- Lateral

Question 17

How can elbow dislocations be identified on x-ray?

Answer 17

Loss of radiocapitellar and ulnotrochlea congruence

I think this just means the elbow is out of its socket lmao

Question 18

When is CT imaging useful in elbow dislocation?

Answer 18

Only in cases with associated fractures

Question 19

What is the initial management of dislocated elbow?

Answer 19

Closed reduction

Question 20

What are the basic methods for closed reduction of elbow dislocation?

Answer 20

• In line traction

- Manipulation of olecranon

Question 21

What do you need to ensure when reducing dislocated elbow?

Answer 21

Sufficient analgesia +/- sedation if appropriate

Question 22

What should be done once elbow has been reduced?

Answer 22

• Apply above-elbow backslab to keep elbow at 90 degrees
• Plain film radiograph to confirm reduction
• Re-assess neurovascular status

Question 23

What is further management of elbow dislocation post-reduction dependant on?

Answer 23

Presence of associated fracture

Question 24

How can simple elbow dislocation with no fracture be managed after reduction?

Answer 24

Outpatient followup, following with a short period of immobilisation (5-14 days, depending on local practice). Early rehabilitation with supervised range of motion exercises in the stable arc can be introduced.

Question 25

When may operative fixation of elbow dislocation be required?

Answer 25

• Fracture
• Open type injury
• Neurovascular compromise

Question 26

What is a common complication of elbow dislocation?

Answer 26

Early stiffness with loss of terminal extension

Question 27

What is the most common neurovascular injury in elbow dislocation?

Answer 27

Stretching of the ulnar nerve

Question 28

What long-term complication may arise with elbow dislocation?

Answer 28

Recurrent instability

Question 29

What may be required with recurrent instability after elbow dislocation?

Answer 29

Future surgery

Question 30

What is the terrible triad?

Answer 30

An elbow dislocation with;

• Lateral collateral ligament injury
• Radial head fracture
• Coronoid fracture

Question 31

What does the terrible triad cause?

Answer 31

Very unstable elbow and poor outcome

Question 32

What is the mechanism of injury causing the terrible triad?

Answer 32

Fall onto extended arm with rotation, resulting in posterolateral dislocation

Question 33

What are patients likely to have long-term with terrible triad?

Answer 33

Recurrent problems with instability, stiffness, and arthrosis

Question 34

What is the treatment for terrible triad?

Answer 34

Operative fixation of each of the components