see also: [[paediatric elbow]], [[Supracondylar humerus fractures]], [[Neurovascular assessment]], [[Monteggia fracture-dislocation]] > A dislocated elbow may be confused with a displaced [[Supracondylar humerus fractures|supracondylar fracture]] on clinical exam; review relationship between olecranon to epicondyles. see: [[Neurovascular assessment#Upper limb|elbow anatomy]] ![[Pasted image 20251113104811.png]] # Treatment ***Reduce posterior dislocation:*** (more common) > Distal traction on the wrist with elbow in some flexion with counter traction on the humerus. direct pressure with thumbs over the olecranon process also helpful *Rosen:* - Assistant immobilises the humerus and applying counter traction while traction is applied to the distal forearm. - Elbow flexed at 30 degrees with the forearm supinated while distal traction is applied. - When the capitellum slides over the coronoid process, a coupling sound occurs as the articular surfaces mesh. - If reduction is unsuccessful, clinician should apply downward pressure at the proximal forearm and apply pressure behind the olecranon while maintaining in-line traction. Downward force may help "unlock" the coronoid process, which may be trapped in the olecranon fossa. - After reduction, move joint through normal range of motion to check stability and check [[Neurovascular assessment|neurovascular status]] before and after reduction attempt ***Reduce anterior dislocation:*** - distal traction on the wrist, with backwards pressure on forearm and counter traction on the humerus apply backslab to arm in 90 deg and sling *Rosen:* - Distal traction of the wrist and a backward pressure on the forearm while the distal humerus is grasped. - A clicking sound usually indicates that reduction has been achieved. > Anterior dislocations have a higher incidence of vascular impairment than the more common posterior dislocation, although ulnar nerve injuries are rare ## Reduction techniques ![[image 3.jpg]] ![[Pasted image 20250622121124.png]] > [!caption] 1. side-to-side manipulation is used to correct medial or lateral displacement ![[Pasted image 20250622121212.png]] > [!caption] 2. The elbow is then flexed while maintaining longitudinal traction # Complications see: [[Neurovascular assessment#quick upper limb peripheral nerve exam|quick upper limb neuro exam]] - [[Neurovascular assessment#Neurovascular structures and injury risks table|brachial artery]] (8% of cases) - [Medial epicondyle fracture](x-devonthink-item://974A4B53-100F-4135-8702-BB6B172C6B22) - most common associated fracture - important to distinguish a medial epicondyle fracture from a (rare) medial condyle fracture, which is an intraarticular fracture requiring urgent ORIF - may be associated with entrapped ulnar nerve neuropathy - arise from valgus dislocations where the medial epicondyle is pulled off by the attached tendons. When the displacement is extreme, the epicondyle can be entrapped in the elbow joint - median nerve - [[#Terrible Triad Injury]] - myositis ossificans (late) -- heterotrophic bone formation ; can result in chronic pain and restriction of movement ![[Pasted image 20251113103842.png|Medial epicondyle fracture: green arrow indicate where medial epicondyle should be, and red arrow indicate that it is entrapped inside the ulnohumeral joint space]] ## Terrible Triad Injury 1. elbow dislocation (often associated with posterolateral dislocation or LCL injury) 2. radial head or neck fracture 3. ulnar coronoid fracture - fall on supinated forearm and extended arm that results in a combination of valgus, axial, and posterolateral rotatory forces  produces posterolateral dislocation - Treatment is generally ORIF versus radial head arthroplasty, LCL reconstruction, coronoid ORIF, and possible MCL reconstruction. ![[Pasted image 20251113103112.png]] ![[Pasted image 20251113103125.png]] ![[Pasted image 20251113103152.png]] # OSCE - [ACEM 2016.1B station 10](x-devonthink-item://636661DB-689A-4DC1-99CA-A739C3037CF6)