Elbow Dislocation in Emergency Medicine Treatment & Management

  • Author: James E Keany, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jul 20, 2011
 

Prehospital Care

Prehospital personnel should splint the limb in the position found. Because of the risk of neurovascular injury, field reduction is not recommended. Successful reduction is usually unsuccessful without adequate analgesia and sedation. Patients with neurovascular compromise should be transported rapidly to the closest facility.

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Emergency Department Care

  • Early reduction is essential, since delay may increase risk of neurovascular compromise or damage to articular cartilage.
  • The emergency physician should attempt reduction after obtaining appropriate radiologic studies if evidence of vascular compromise is noted or if orthopedic consultation is delayed significantly.
  • The following 2 methods commonly are used for posterior elbow reductions. Be certain that the patient has received adequate analgesic and sedative medications before beginning either procedure. Also see, Joint Reduction, Elbow Dislocation, Posterior.
    • With the elbow flexed to 90 degrees and supinated, apply posterior pressure to the humerus while a second operator applies downward pressure on the proximal forearm. A coupling is felt and heard as the capitellum slides over the coronoid process and the joint realigns.
    • The second method (the Parvin method) involves placing the patient in the prone position with the humerus resting on the table and the forearm hanging perpendicular to the plane of the table. The humerus should be supported by the table, with padding, just proximal to the elbow joint. Apply 5-10 lb of weight to the wrist or gently pull down at the wrist. Reduction should occur over a period of minutes as the muscles relax. The physician may guide the olecranon into place if necessary.
  • Anterior dislocation reduction is performed with distal traction on the wrist and backward pressure on the forearm. Take care to avoid hyperextension at the elbow, which may cause traction and potential injury to neurovascular structures around the elbow.
  • Postreduction neurovascular check should always be performed as the brachial artery and the median and ulnar nerves can become entrapped with manipulation.
  • A failed closed reduction is indicative of an entrapped medial epicondyle or an inverted cartilaginous flap.
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Consultations

  • Emergent orthopedic consultation should be sought for all patients with elbow dislocations.
  • Vascular surgery consultation may be needed in patients with possible vascular injury.
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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

References

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