Elbow Dislocations

Classification
Posterior / Anterior / Lateral / Medial / Divergent




Examination
Exclude neurological injuries: median, ulnar, anterior interosseous, radial nerves
Exclude brachial artery disruption, compartment syndrome
X-rays
AP and lateral views of the elbow
Determine direction of dislocation
Exclude associated fractures: radial head, radial neck, medial or lateral epicondyle, olecranon, coronoid process
Management
Prompt reduction at A&E after X-rays reviewed.
Check and document neurovascular status before and after reduction.
Check X-rays are mandatory after M&R.
IV pethidine 50mg +/- sedation with IV midazolam
Posterior dislocation: Distal traction on forearm with elbow flexed and countertraction on distal humerus. (Beware of fracturing coronoid process)
Anterior dislocation : Posterior and downward pressure on flexed forearm while distal humerus is pushed forward
If reduction successful: Long arm backslab with elbow in 90 flexion. Triangular arm sling. Admit to Ortho Dept for circulation chart.
If reduction unsuccessful: contact Ortho MO-on-call stat for further management.