Elbow Dislocation in Emergency Medicine Treatment & Management

Updated: Jan 21, 2016
  • Author: James E Keany, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
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Treatment

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 the risk of neurovascular compromise or damage to articular cartilage. [3]  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. [4, 5, 6]

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. Reed et al cite a case of acute ulnar nerve entrapment after closed reduction. [7]

Patients with dislocations of the elbow should not be transferred until the elbow has been reduced. In hospitals without access to an orthopedic surgeon, reduction should be performed by the emergency physician prior to transfer.

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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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Complications

Following reduction, splint elbow in at least 90 degrees of flexion using a posterior molded splint. Arrange close follow-up care with the orthopedic surgeon. In a self-reported study of patients sustaining simple elbow dislocations, despite a good long-term functional prognosis, there was a relatively high rate of residual pain and elbow stiffness. Therefore, it is important for patients to receive timely outpatient follow-up with an orthopedic specialist. [8]

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