A 50 Year old builder presents to A+E after falling from a ladder and landing onto his right arm. A primary survey and secondary survey has been completed. The only injury of note is swelling and tenderness over his Right elbow.
This is a lateral and AP plane film radiograph of a skeletally mature individuals right elbow. The most obvious abnormality is that there is a posterior dislocation of the elbow.
I would perform this procedure under sedation in the emergency department. I would flex the elbow to 30 degrees in supination to unlock the olecranon from the olecranon fossa, following this I would apply longitudinal traction and gently lever the olecranon over the distal humerus.
After reduction I would take the elbow through gentle range of movement to confirm congruent reduction has been obtained and can be maintained. Then I would place the elbow in an above elbow backslab for review in 10 days following this provided stable they could be placed in a hinged elbow brace for 2-3 weeks.
You successfully reduce the elbow.
- Fracture of the radial head
- Dislocated elbow
- Coronoid fracture
- LCL complex
- Anterior MCL bundle
- Ulnohumeral joint
- Radiocapitellar joint
- Flexor and extensor origins
- The anconeus
O’Driscoll has described the pathoanatomy of elbow dislocations. He has described a ring of instability caused by sequential tearing of the soft tissues. Patients axially load a supinated forearm. The sequence of tearing:
- Lateral collateral ligament
- Anterior capsule
- Medial collateral ligament
- Common flexor or extensor origins may also be avulsed.