Anterior dislocation of elbow is quite rarer as compared to posterior dislocation. It usually occurs after a fall which results in a force striking the posterior forearm in the flexed position.
Because of the mechanism of injury, a fracture of the olecranon commonly occurs with this injury.
Clinical Presentation
Pain swelling and deformity are the usual presenting complaints. The arm appears shortened and forearm is in supination. The distal humerus is prominent posteriorly. The biceps tendon tents the skin anteriorly. Because the the dislocation is anterior, injury to nerve and vessel can occur frequently. Therefore, careful assessment for neurovascular injury is mandatory.
Associated fracture of olecronon may be found.
Investigations
Anteroposteriror and lateral views of the elbow are sufficient for diagnosis. In case of a vascular injury appropriate investigations like color doppler and arteriography help to find the injury and plan the treatment.
Methods of Treatment
The reduction maneuver is the reverse of the posterior dislocation.
- Gentle traction is first applied to the forearm to relax the contracted muscles.
- Posterior and downward pressure is then applied to the forearm with gentle anterior pressure on the posterior aspect of the distal humerus.
- After the reduction, a careful neurovascular examination must be done.
The triceps insertion may be injured in this type of dislocation, and can be known by active extension of elbow.
The elbow is splinted in slightly less than 90 degrees of flexion, depending on the amount of swelling and the status of the triceps.
If there is an associated olecranon fracture, open reduction with rigid fixation for stability should be done.
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