History
Obtain history that includes the mechanism of injury, type and location of pain, amount of immediate dysfunction, treatment prior to arrival in the emergency department, timing of effusion appearance, and history of prior elbow injury.
-
Mechanisms - A fall onto an extended, abducted arm (posterior) or a direct blow to a flexed elbow (anterior)
-
Pain - Intense, focused around the elbow joint
-
Extremely limited range of motion
-
Effusion
Physical
In posterior dislocations, the elbow is flexed, with an exaggerated prominence of the olecranon. On palpation, the olecranon is displaced from the plane of the epicondyles (as opposed to a supracondylar fracture, in which the epicondyles are palpable in the same plane as the olecranon).
In anterior dislocations, the elbow is held in full extension. The upper arm appears shortened, while the forearm is elongated and held in supination.
Neurovascular function should be documented in detail before and after reduction. Continued repeated examination is essential.
Indications for admission with frequent neurovascular assessment include the following:
-
Children
-
Unreliable patients
-
Extensive edema
-
Evidence of neurovascular compromise either before or after reduction
Complications
Complications of elbow dislocation may include the following:
-
Brachial artery injury [1]
-
Medial nerve injury
-
Ulnar nerve injury
-
Concomitant fractures
-
Avulsion of the triceps mechanism insertion (anterior dislocation only)
-
Entrapment of bone fragments within the joint space
-
Joint stiffness with decreased range of motion (particularly in extension)
-
Myositis ossificans
-
Compartment syndrome
-
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.
