Elbow Dislocation

The procedure for the management of elbow dislocations includes:

Analgesia

Analgesia should be provided prior to attempts to reduce the dislocation. Reduction using short-acting analgesic agents such as Entonox or Penthrox may be possible but in some cases reduction using procedural sedation or even reduction under general anaesthetic may be required.

Fig. 10: Posterior elbow dislocation

Reduction techniques

Several techniques for reduction of a posteriorly dislocated elbow are recognised:

Fig A: With the elbow flexed to 60 degrees provide traction to the pronated forearm and counter-traction to the distal humerus	Fig B: Lever the olecranon forwards whilst traction is being provided to the forearm	Fig C: Position the patient prone with the abducted humerus resting upon the bed and pronated forearm hanging towards the floor. Provide traction to the forearm and downward pressure to the olecranon

Post reduction

Reduction should be immediately followed by a further assessment of limb neurovascular status. Successful reduction is then confirmed by repeat x-ray. This will also enable assessment of the new position of any associated fractures.

The reduced elbow can be immobilised in a sling or splint in 90 degrees of flexion. In cases where there are concerns over neurovascular impairment or significant elbow swelling a period of observation should follow. This is due to the possibility of compartment syndrome developing in the forearm fascia or biceps tendon. Outpatient orthopaedic review should subsequently be arranged. Myositis ossificans may later develop as a result of large elbow haemarthroses.

Learning bite

Post-reduction assessment of neurovascular status and repeat x-ray is essential.