MANUAL MINORS
Elbow dislocations occur when the bones of the forearm (radius and ulna) are displaced from their normal position relative to the humerus in the elbow joint. It is the second most common dislocation in adults, after shoulder dislocations, and usually results from indirect trauma, such as a fall onto an outstretched hand.
Dislocations can be complete (with full dislocation) or partial (subluxations). They may also involve fractures, and can damage ligaments and neurovascular structures.
Diagnosis
Diagnosis is made through clinical evaluation, where visible deformity in the elbow, swelling, intense pain, and loss of mobility are observed. Anteroposterior and lateral X-rays of the elbow confirm the dislocation and rule out associated fractures. In some cases, additional studies such as computed tomography (CT) or magnetic resonance imaging (MRI) are required to assess ligament injuries or complex fractures.
Differential Diagnosis
Condition | Characteristics |
|---|---|
Supracondylar fracture | Occurs in the distal humerus, with pain and deformity. |
Radial head fracture | Localised pain on the external side of the elbow, limited mobility. |
Olecranon fracture | Pain and deformity in the posterior elbow, visible on X-rays. |
Epicondylitis | Pain without obvious deformity, affecting tendons without dislocation. |
Traumatic synovitis | Swelling and pain after trauma, without joint displacement. |
Emergency Management
Emergency management of an elbow dislocation involves urgent reduction to restore anatomical alignment and prevent damage to neurovascular structures. Reduction can be performed under sedation or local anaesthesia, followed by immobilisation of the elbow with a posterior splint.
Before and after reduction, it is essential to assess vascular integrity (pulses) and neurological status (radial, median, and ulnar nerves). If closed reduction is not possible, surgical intervention is required.
Definitive Treatment
After successful reduction, the elbow is immobilised for 1 to 3 weeks depending on joint stability. Prolonged immobilisation is avoided to prevent joint stiffness. Physical therapy is initiated afterward to restore mobility and strength.
In dislocations associated with fractures or ligament damage, surgical intervention may be necessary to repair the affected structures and stabilise the elbow using screws, plates, or ligament grafts.
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