Elbow is a very important part of upper limb function and plays very important role in positioning of the hand for grip and prehension. Various day to activities and rcrecreational and sports activities require a wide range  movement at the elbow in both flexion and extension and forearm rotation.

Elbow is relatively a stable joint and is dislocated by sufficient force. Because of their vicinity, neurovascular bundle is quite vulnerable to injury in elbow dislocation.

Classification

Most acute elbow dislocations in adults occur at the ulnohumeral joint. For purpose of terminology, most classifications refer to the position of the ulna relative to the humerus after injury.

Injury can be classified as

• Posterior
• Posteromedial
• Posterolateral
• Anterior
• Medial
• Lateral
• Divergent

A posterior dislocation,  refers to the ulna and radius sitting posterior to the humerus.

Most acute elbow dislocations are posterior and involve both the radius and ulna. Anterior, medial, lateral, and divergent forms are very rare.

Mechanism of Injury

Posterior dislocations of the elbow are commonly caused by a fall on the hand or wrist. As force is transmitted from the fall to the extended elbow, a resultant anterior force is generated that levers the ulna out of the trochlea. As the joint continues to hyperextend, the anterior capsule and collateral ligaments are placed under increasing tension and eventually fail.

Anterior dislocation may be caused by impact on the posterior forearm in a slightly flexed position.

Clinical Presentation

The patient would present with a history of fall on the hand or wrist.There would be history of elbow giving way after that following which the patient was unable to use his elbow. The patient would complaint of extreme pain in the elbow and would support his upper limb to prevent any movement at elbow.

The first priority of care is to assess the neurovascular status of the hand and forearm. Brachial artery and median and ulnar nerves  are most vulnerable .  Xrays, anteroposterior and lateral views of ebow are  studied for associated fractures around the elbow.

Treatment

An uncomplicated pure dislocation of elbow can be easily treated by closed methods. In case of associated fractures, the treatment varies according to fracture pattern. Fracture of the humerus, olecronon, coronoid process  or radial head fractures can occur along with dislocation of the elbow.

In case of vascular injury, the repair of the vessel is first priority. However in associated nerve injuries, the treatment of closed reduction and plaster application can be very well initiated and observed.

If the dislocation is open with a large wound over the elbow, surgery is almost always required.

Reduction Technique and Plaster Work

• The patient is placed supine on the table under general anaesthesia or sedation  if GA is not available for some reason or other.
• An assistant holds the arm, above the elbow, preferably near shoulder to pull while the physician applies traction in the direction of the deformity.
• A give way sensation is felt.
• Following this, the elbow is flexed to more than nintey degree. If it is not possible to reduce it more than ninety degrees, the fracture has not reduced yet.
• Neurovascular examination is done to rule out any entrapment
• An above elbow slab is applied in hyperflexion i.e. elbow flexed more than ninety degree.
• The position is confirmed in the xrays.
• After two weeks, the elbow is brought to ninety degree of flexion and plaster is continued for another 6 weeks.

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Related posts:

1. Anterior Dislocation Of Elbow
2. Medial, Lateral and Divergent Dislocation of Elbow
3. Dislocation of Elbow With Fracure of Radial Neck – Anteroposterior and Lateral Views
4. Vascular and Neural Injury In Dislocation of Elbow
5. Neglected or Unreduced Posterior Dislocation of Elbow