ELBOW DISLOCATION

INTRODUCTION:
  • Dislocation of ulnohumeral joint in adult more than in children , radioulnar complex is displaced posteriorly or posterolateral often together with fractures.
  • Posterior dislocation the common type
  • Three point bony relationship in elbow:
  • Tips of medial & lateral epicondyles and the olecranon process forms an isosceles triangle when the elbow is flexed & lies transversely in a straight line when the elbow is extended.
  • Relation is maintained in supracondylar fracture of humerus.
  • Relation is disturbed with increased intercondylar distance
  1. Fracture medial condyle & epicondyle
  2. Fracture lateral condyle & epicondyle
  3. Fracture intercondylar humerus.
  • Relation is disturbed with maintained intercondylar distance
  • Fracture olecranon
  • Elbow dislocation
MECHANISM OF INJURY:
  • Because fall on the out striated hand with the elbow extend .
  • Disruptur of capsuloligamentous structure alone it also lead to posteriolateraly dislocation.
  • Dislocation without recurrent dislocation
  • Fracture medial epicondyle
  • Not the combination of fractures.
TYPES:

Posterior dislocation Lateral dislocation
  • If there is tissue damage may combined with surrounding nerve and vesicular damage sid-swip injury / in car drivers elbow the result forward dislocation with fracture of bone around elbow , soft tissue damage usually sever Clinical features slight flex hand , swelling , deformity , bony land mark in abnormal place , pain ,the hand should be examine for neurovesicular damage
Treatment
  • Anatomical reduction is essential should be soon as possible .
  • The majority of cases are treated conservatively .
  • Surgical intervention may be indicated fore the associated fractures .
  • Reduction by traction on the forearm in the position in which it lies ,in order to over com biceps and triceps shorting , at the same time the olecranon is pushed forward by thump whilst the elbow is slowly flexed . The stability is then checked by gently moving the elbow through its normal range
  • Immobilization : this can be achieved by collar and cuff with or without a posterior slab for 3 week with elbow at 90 flexed
  • Rehabilitation Shoulder and finger exercise should command at once .while genteel active .Elbow exercise should common after on week.
  • Anterior dislocation
COMPLICATIONS:
  • Vascular injury of brachial artery may occur but with a lesser frequency than in cases of supracondylar fracture
  • Nerve injury :the median, ulnar nerve may be affected
  • Myositis ossification ,which is more common if passive exercise is inflicted on the patient.
  • Recurrent of the dislocation may occur if the bony , ligamentous, and muscular support structure are disrupted sufficeintly.
  • Late complications
  1. Stiffness
  2. Heterotopic ossification
  3. unreduced dislocation
  4. Recurrent dislocation
  5. Osteoarthritis after sever fracture dislocation.
PULLED ELBOW:
  • Nursemaid's elbow, Babysitter's elbow or Pulled elbow is a dislocation of the elbow joint caused by a sudden pull on the extended pronated arm, such as by an adult tugging on an uncooperative child, or swinging the child by the arms during play. The technical term for the injury is radial head subluxation.
  • Common in children below 5 years of age
FEATURES:
  • The child stops using the arm, which is held flexed and pronated.
  • Minimal swelling.
  • Pain
  • All movements are permitted except supination.
  • The child cries inconsolably
  • Norma: X-ray
Treatment:
  • The affected arm must be held by the attending physician with one hand/finger on the radial head and the other grasping the hand.
  • While applying compression between these two hands, the forearm of the patient is gently supinated and the arm flexed.
  • The physician will usually feel a "click" if the maneuver is done properly, the child will feel momentary pain, and usually within 5 minutes, the forearm will thereafter function well and painlessly.
Exam Question
  • Pain around elbow which is held in pronation with extension and normal X ray is diagnosed with pulled elbow
  • Most common type of Elbow dislocation is Posterior
  • Most common associated injury of fracture medial epicondyle is Elbow dislocation
  • Three point relationship is reversed in Elbow dislocation, Medial & lateral epicondyle fracture
  • A child is spinned around by holding his hand by his father. While doing this the child started crying and does not allow his father to touch his elbow. The diagnosis is Pulled elbow
  • Myositis ossificans follows either a posterior dislocation or a spuracondylar fracture of elbow joint
  • Pulled Elbow is Subluxation of proximal radio ulnar joint or Dislocation of head of radius
  • Vascular injury,Median nerve injury, Myositis ossificans are the Complications of elbow dislocation
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