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Elbow Dislocations

By Danielle Campagne, MD , Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

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Patient Education

Most elbow dislocations are posterior and usually result from a fall on an extended arm.

Posterior elbow dislocations are common; it is the 2nd most common joint dislocation after shoulder dislocations. Associated injuries may include fractures, injuries to the ulnar or median nerve, and possibly injury to the brachial artery.

The joint is usually flexed about 45°, and the olecranon is prominent and posterior to the humeral epicondyles; however, these anatomic relationships may be difficult to determine because of swelling. Classically, patients with an elbow dislocation present with a shortened forearm and a very prominent olecranon.

X-rays are diagnostic.

Treatment

  • Traction to reduce the elbow joint, usually with procedural sedation

Reduction is usually with sustained, gentle traction and correction of deformity after patients are sedated and given analgesics. The following technique is commonly used:

  • With the patient supine, the practitioner flexes the elbow to about 90° and supinates the forearm.

  • An assistant stabilizes the upper arm against the stretcher.

  • The practitioner grasps the wrist and applies slow, steady axial traction to the forearm, while keeping the elbow flexed and the forearm supinated.

  • Traction is maintained until the dislocation is reduced.

After reduction, the practitioner checks the elbow for stability by fully flexing and extending the elbow while pronating and supinating the forearm. These movements should be easy after reduction. After reduction, an x-ray should be taken to make sure no fractures were missed.

The joint is usually immobilized (eg, in a splint) for up to 1 wk until pain and swelling resolve; then active range-of-motion exercises are started, and a sling is worn for 2 to 3 wk.

Key Points

  • Many patients with an elbow dislocation present with a shortened forearm and a very prominent olecranon; the position of the bones may be difficult to determine because of swelling.

  • Take x-rays to diagnose a dislocated elbow.

  • Apply gentle, sustained traction to reduce the joint after patients are sedated and given analgesics.

  • After reduction, check the joint for stability, take x-rays to check for fractures, and immobilize the joint.

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