Medial, Lateral and Divergent Dislocation of Elbow

These are rarer and unusual  forms of  dislocations of elbow.

Medial and Lateral Dislocations

Medial Dislocation of Elbow

Medial and lateral dislocations present with a widening of elbow. However, the relative lengths of the arm and forearm are not changed much.

The patient presents with typical symptoms of pain swelling and the diagnosis should be suspected if mediolateral widening of elbow is present.

Anteroposterior and lateral views are sufficient to make the diagnosis.

In the anteroposterior x-ray, a pure medial or lateral dislocation shows the greater sigmoid notch of the ulna in the plane of the distal humerus

The clinical diagnosis can be difficult in some cases especially in some patients  of  lateral dislocations with considerable swelling.

as with other orthopaedic injuries, neuarl and vascular examination must be done to rule out the injury to these structres.

Lateral Dislocation of Elbow

Treatment

The treatment of pure medial and lateral dislocations is closed reduction followed by splintage in reduced position for the required period. In case of associated  fractures or failure of closed reduction, surgery might be needed.

Technique

In supine position the arm is held in mild extension position  and assistant holds the arm for counter-traction.

Traction is applied to distal forearm while the assistant applies counter traction. When the arm gets its length back,  gentle pressure is applied in medial or lateral direction.

If soft tissue is interpositioned in between two joints, such as the anconeus, it may block closed reduction of the dislocation and necessitate open reduction.

Divergent Dislocation of the Elbow

Divergent dislocation of the elbow is another rare type of dislocation. In this the radius and ulna dislocate in diverging directions.

There are two types of this dislocation

• Anteroposterior
• Mediolateral  or transverse.

Divergent Dislocation of Elbow

Anteroposterior type is more common.  It this, a posterior dislocation of the ulna occurs resulting in lodging of coronoid process in the olecranon fossa. The radial head is lies anteriorly in the region of the coronoid fossa.

This kind of injury occurs when  the forearm is  in forced pronation and the humerus is forced distally, separating the radius and ulna.

This injury causes massive soft tissue trauma and along with ligaments of elbow, the interosseous membrane is torn.

Examination and investigations are done in usual manner.

Treatment

Reduction technique is similar to that of a posterior dislocation. As the ulna dislocation is being reduced, pressure is applied directly over the radial head to reduce it.

If radial head tends to dislocate and is not stable, the patient may require operative intervention. After this injury the elbow should be immobilized in flexion with the forearm in position of  supination to prevent radial head from redislocation. Rehabilitation is similar to other types of elbow dislocation

In mediolateral (transverse) type the elbow appears markedly widened. Reduction maneuvar is similar to previous injury.

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