MANUAL MINORS
Elbow dislocation occurs when the bones of the forearm (radius and ulna) are displaced from their normal position relative to the humerus. This type of injury is the second most common dislocation in adults and generally results from indirect trauma, such as a fall onto the hand with the elbow extended.
The dislocation can be simple, with no associated fracture, or complex, if accompanied by fractures. The most frequent type is posterior dislocation, where the ulna and radius are displaced backward.
Diagnosis
The diagnosis is based on a history of acute trauma, such as a fall, along with symptoms like severe pain, obvious deformity of the elbow, swelling, and complete loss of mobility. Anteroposterior and lateral X-rays of the elbow confirm the dislocation and help rule out associated fractures.
In some cases, additional studies such as computed tomography (CT) or magnetic resonance imaging (MRI) may be required to assess complex ligament injuries or fractures not clearly seen on X-rays.
Differential Diagnosis
Pathology | Characteristics |
Supracondylar fracture | Common in children, deformity, and pain in the elbow, visible on X-rays |
Radial head fracture | Pain and limited mobility on the outer side of the elbow |
Olecranon fracture | Deformity and pain in the back of the elbow |
Elbow subluxation | Partial displacement with less pain and deformity |
Traumatic synovitis | Swelling and pain without joint displacement |
Emergency Management
Urgent treatment for an elbow dislocation includes immediate reduction of the joint to restore its normal alignment. This is performed under sedation or local anaesthesia. It is essential to assess circulation and nerve function before and after the reduction to rule out vascular (brachial artery) or nerve injuries (radial, ulnar, or median nerves). After reduction, the elbow is immobilised with a posterior splint, avoiding full extension to prevent instability.
Definitive Treatment
Once reduction is achieved, the elbow is briefly immobilised (1 to 3 weeks), followed by a physiotherapy programme to restore mobility and prevent stiffness. If the dislocation is unstable or accompanied by fractures, surgical intervention may be required to repair damaged ligaments or stabilise fractures with plates or screws. Postoperative physiotherapy is essential to avoid complications such as osteoarthritis or loss of range of motion.
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