Elbow Dislocation in Emergency Medicine

Author: James E Keany, MD, FACEP; Chief Editor: Rick Kulkarni, MD more...

Updated: Jul 20, 2011

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Background
Pathophysiology
Epidemiology
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Background

The elbow joint displays an elegant balance between stability and mobility. While allowing a wide range of motion, the joint has an inherent stability that requires a considerable force to dislocate. As a result, a significant percentage—approximately one third of elbow dislocations—are associated with fractures of bony components of the elbow. Dislocations without associated fracture are termed simple, while dislocations with accompanying fracture are termed complex.

Dislocations of the elbow fall in frequency just behind dislocations of the finger and shoulder. Most commonly, the elbow dislocates posteriorly. Immediate reduction is essential to reduce the risk of neurovascular or cartilaginous complications.

Anteroposterior radiograph of the elbow demonstrates the normal anatomy.

Lateral radiograph of the elbow demonstrates the normal anatomy.

Pathophysiology

Both posterior dislocations and anterior dislocations can occur.

Posterior dislocations

A fall onto an extended abducted arm is the mechanism of injury seen in posterior dislocations of the elbow. An example of this is someone rollerblading who, falling backward, extends an arm behind to break the fall. Posterior dislocations account for most elbow dislocations. Closed posterior dislocations are not commonly associated with neurovascular injury.

Lateral view of the elbow demonstrates a posterior dislocation of the elbow. The patient also had a nondisplaced radial head fracture.

Anterior dislocations

A strong blow to the posterior aspect of a flexed elbow may result in anterior dislocation of the elbow. This force drives the olecranon forward in relation to the humerus. Anterior dislocations and any open fracture are commonly associated with disruption of the brachial artery and/or injury to the median nerve.

Sex

Elbow dislocation injuries occur more often in males than in females.

Age

Dislocations occur more commonly in adults, since the same force in children more often results in a supracondylar fracture of the distal humerus.

Proceed to Clinical Presentation

Contributor Information and Disclosures

Author

James E Keany, MD, FACEP Medical Director, TravelMDAssist; Staff Physician, Department of Emergency Services, Mission Hospital Regional Medical Center

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Dekker McKeever, DPM Chief Podiatric Surgery Resident Physician, Trauma and Reconstruction Specialist, Mission Hospital Regional Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph J Sachter, MD, FACEP Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center

Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

David B Levy, DO, FACEP, FAAEM Chairman, Department of Emergency Medicine, St Elizabeth Health Center; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Medical Informatics Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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