HWN Suggests

How to Perform Seven Elbow Dislocation Reduction Techniques

Throwin’ bows back in - A vast majority (98.5%) of elbow dislocations are posterior, with fractures occurring in >50% of cases—usually to the coronoid or radial head. In 16-22% of cases, nerve injury (usually median or ulnar) occurs, with most improving post-reduction. Rarely, brachial artery rupture may occur. Reduction techniques are described... but also look at the visuals for each—a picture is worth a thousand words...

read full article

Featured

  Simple Reduction Procedure

This video is about how to reduce elbow dislocations...

 Elbow Dislocation

Parvin’s method: patient lies prone with entire upper extremity hanging off the bed, downward traction is applied to the wrist for a few minutes—> olecranon slips distally, arm is then lifted gently (Method A). Meyn & Quigley method: forearm hangs off of bed, gentle downward traction is applied to wrist, olecranon is guided with opposite hand (Method B).

Articles of Interest

A Novel Reduction Technique for Elbow Dislocations

The patient is positioned supine and pulled to the edge of the stretcher to facilitate access to the injured elbow. For a right elbow dislocation, the physician first places his or her left mid-humerus in the patient’s right antecubital fossa with the shoulder flexed to near 90°. The physician then flexes his or her left elbow while grabbing the patient’s right wrist or hand with his or her left hand. The patient’s right elbow is maintained in approximately 90° or greater of flexion. Once the patient’s wrist or hand is grasped, extension or flexion of the patient’s elbow can be provided by the physician internally or externally rotating his or her shoulder. The physician’s right hand is then placed just distal to the antecubital fossa on the patient’s volar forearm. As the physician extends his or her left elbow, an axial traction force is created on the patient’s arm. This motion is similar to throwing a dart or tomahawk. The placement of the physician’s mid-humerus over the patient’s humerus, just proximal to the antecubital fossa, provides a static countertraction force during this motion. The physician’s right hand is pulled across his or her body to provide a distracting force on the patient’s elbow. This motion is similar to drawing a bow; however, this hand can also be used to rotate the forearm, creating hypersupination of the forearm to unlock the radius prior to extension of the physician’s left arm. These motions allow for complete control of the patient’s elbow in all planes of motion during the reduction. Once the physician has control of the patient’s flexion-extension, pronation-supination, and distraction, he or she can provide gentle force with both hands until the elbow is felt to reduce. Once the elbow is reduced, the physician uses his or her right hand to place the patient’s forearm in pronation and hyperflexion to secure the reduction and hold the patient’s arm while removing his or her left arm from the reduction position.

A novel technique for reduction of posterior dislocation of the elbow joint

Our technique has several advantages when compared with previous published techniques. Firstly, it is performed supine permitting its use in the setting of a multiply injured patient. Secondly, it does not require traction or pressure on the antecubital fossa which could damage compromised anterior neurovascular structures. Thirdly, it can be performed without muscle relaxant.

Closed Reduction Techniques for Elbow Dislocations

The elbow is the second most commonly dislocated adult joint and the most commonly dislocated joint in children. Elbow dislocations are classified as simple or complex. Simple implies a pure dislocation, although small avulsion fractures may be present up to 2 mm in diameter. Complex dislocations are associated with fractures of the olecranon, radial head, or coronoid process.

Elbow Dislocations - Peds

But beware: elbow dislocations rarely present in isolation. They often coexist with other elbow injuries. Associated fractures are likely to occur prior to closure of the epiphyses; when they are closed, collateral ligaments are likely to be ruptured. The most common associated fracture is a medial epicondyle avulsion which can become incarcerated in the joint – scrutinize the elbow x-rays for associated fractures.

Elbow Injuries – Ten Pitfalls in Diagnosis and Management

Although it doesn’t get the spotlight much in emergency medicine, the ED diagnosis and management of elbow injuries is of significant clinical importance. There are several easy-to-miss injuries that can lead to functional impairment. Even minor errors in management can result in long term consequences for patients.

Funny Bone, Serious Problem

Elbow dislocations are quite painful and often times accompanied by other injuries. ED providers caring for a patient with an elbow dislocation must be sure to properly examine and x-ray patients prior to putting an elbow back in place. Be wary of the associated complications to dislocations including fractures and nerve or artery injury. Soft tissue damage and swelling are also very common.

Managing Elbow Dislocations

In this section, I will focus on the 3 predominant techniques for posterior dislocations and 1 technique for anterior dislocations.

New To ED: Elbow Dislocation

How to reduce posterior dislocation elbow...

Novel Technique for Closed Reduction of Incarcerated Medial Epicondyle from the Elbow Joint

While the majority of pediatric elbow dislocations are associated with a medial epicondyle fracture, an intra-articular incarcerated medial epicondyle is a rare sequela of closed elbow reduction. Elbow dislocations with incarceration of the medial epicondyle in the elbow joint have typically been considered an absolute indication for surgical intervention as closed manipulation is often unsuccessful according to the literature. We demonstrate a novel technique in which the incarcerated medial epicondyle can be extricated from the joint without having to go to the operating room, thus allowing for conservative management of these difficult injuries and reducing the risk of perioperative complications.

Ortho Pearls: The Elbow Dislocation

While complex elbow dislocations (large intra-articular fractures, most commonly of the radial head and/or coronoid process) frequently require surgery due to significant soft tissue injury and joint instability, simple elbow dislocations are reduced in the emergency department with procedural sedation. Just like any extremity injury requiring a reduction, a documented neurovascular exam before and after the procedure is performed. This is particularly important for elbow dislocation as there are several important neurovascular structures in close proximity. Watch out for injuries to the brachial artery (rare, but often subtle), ulnar, or median nerve.

Recent trends in children's elbow dislocation with or without a concomitant fracture

The elbow is the joint that most usually dislocates in children. In contrast to the widely known recent increase in the incidence of upper-extremity fractures and their operative treatment in children, potential trends in elbow dislocation are not clear. In this study we aimed to clarify the recent epidemiology of childhood elbow dislocation, in particular the potential change in incidence and treatment.

SplintER Series: Elbow Injury

Apply longitudinal traction of the supinated forearm with the elbow flexed at 25 to 30 degrees, with countertraction of the upper arm. Apply downward pressure at the proximal forearm and anterior pressure behind the olecranon.

Resources

Life in the Fastlane

When larger intra-articular fractures of the radial head, olecranon, or coronoid process occur with elbow dislocation, the injury is termed a complex dislocation. Complex dislocations are much less common than simple dislocations. The risk of recurrent or chronic instability and posttraumatic arthrosis is increased significantly with complex dislocation.

Ortho Bullets

Reduction maneuver requires a combination of: inline traction to improve coronal displacement, forearm supination to shift the coronoid under the trochlea, elbow flexion while placing direct pressure on tip of olecranon.