Makindo Medical Notes

Introduction

• Elbow dislocation is a common joint injury, typically resulting from trauma such as falls or high-impact accidents.
• It is characterized by the displacement of the ulna and radius from their normal articulation with the humerus.
• Prompt recognition and management are essential to prevent complications, including neurovascular injury and long-term joint instability.

Causes

• Fall on an outstretched hand (FOOSH injury)
• Direct trauma to the elbow
• Sports injuries
• Motor vehicle accidents
• High-energy trauma, particularly in younger individuals

Clinical Features

• Gross deformity: Loss of characteristic “triangular” appearance over the posterior aspect of the elbow
• Assess and document distal neurological function (Beware MEDIAN nerve):
• Nerve and Function Assessment
  • Median Nerve:
    • Motor Function: Thenar Eminence of thumb, adduction on MCPJ, flexion of MCPJ, opposition
    • Sensory Function: Radial border of index finger
  • Radial Nerve:
    • Motor Function: Active wrist extension
    • Sensory Function: Radial border of index finger
• Ulnar Nerve:
  • Motor Function: Intrinsic hand muscles - abduction and adduction of MCPJ
  • Sensory Function: Ulnar border of little finger
• Assess and document distal vascular function
• IV Access and IV morphine prior to X-ray
• Immobilise in a broad-arm sling

X-Ray Findings

• Request ELBOW X-RAY
• Usually, olecranon dislocates posteriorly
• Assess for associated fractures, especially:
  • Radial head/neck
  • Coronoid process
• In case of fracture-dislocation, refer to orthopaedics. DO NOT attempt reduction in ED due to the danger of fracture fragments entering the joint.

Management

• Transfer to resus. Ensure Adequate monitoring
• Consent for procedural sedation. Ensure two doctors are present
• Sedate the patient. Reduce the dislocation, usually with longitudinal traction and slight flexion
• Assess and document distal neurological function post-reduction
• Apply a long-arm backslab before the post-reduction X-ray (reduced joints are often unstable)
• Perform a post-reduction X-ray
• Refer to on-call orthopaedics

Even if reduced, patients are often admitted for elevation and circulation, sensation, and movement checks due to the significant incidence of neurological deficit associated with swelling.

Source: Clyde Emergency Departments, Fracture Management Guidelines