Elbow Dislocation DR - Ahmed Abdali

Injuries around elbow
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Anatomy of elbow joint
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Surface anatomy of elbow
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Elbow dislocation is a Common injury, 90% of dislocations are posterior or posterolateral
note: the imaginary line which pass through the axis of the radius should pass through the capitulum in all views, if it
doesn’t pass, the radial head is dislocated.
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Elbow dislocation
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1 Mechanism 2
Fall on outstretched hand usually Sideswipe injury: when the drivers elbow
.Produce isolated dislocation projected from the care and strikes
by another care ; usually associated with other
fracture around elbow
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Clinical features
 Swelling
 Deformity
 Loss of 3point configuration

of elbow
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Treatment
Simple dislocation: reduction under general anesthesia. Longitudinal traction , thump pressure
over the olecranon , correct the sideway tilt, backslap for 3 week then physiotherapy.
Dislocation with fracture ( olecranon, medial epicondyle, coronoid process) the fracture must be
fixed internally after reduction of dislocation.
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Radial head fracture
Mechanism: fall on outstretched hand with
elbow pronated
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Mason classification
I II III
Type-I: Undisplaced vertical split
Type-II: displaced single fragment
Type-III: comminuted radial head fracture
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Management
Type-I: aspirate hematoma, inject local anesthesia, collar and cuff for 3 weeks, then physiotherapy
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Type-II : reduction of the fragment and fixation by Herbert screw
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Type-III: look for associated injuries like
Fracture coronoid process
Rupture of interosseous membrane (Essex lopresti injury)
If these injuries is present the treatment is either
reconstruction of the head with internal fixation or
replacement with a metal spacer
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If no any of associated injuries is present : excision of radial head done.
Radial head excision is contraindicated in children before closure of
epiphysis and in adult if any associated injuries.
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Terrible triad of elbow
It is a combination of
Radial head fracture
Coronoid fracture
Elbow dislocation
Treatment by open reduction

And internal fixation
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It is of 2 types:
1.Transvers fracture
Fracture olecranon 2. Comminuted fracture.
Each on of these types subdivided to displaced or non displaced
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Mechanism of injury:
1.direct trauma by fall on the point of elbow. Usually lead
to comminuted fracture
2. Indirect trauma by falling with forceful contraction of

triceps muscle, usually lead to transvers fracture
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Treatment:
Undisplaced fracture treated by arm sling for 3 weeks followed by physiotherapy.
Displaced transvers fracture treaded by ORIF by screw and tension band wire
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Displaced comminuted fracture treated by fixation with plate and screw with bone graft
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Fracture lateral condyle in children
Mechanism of injury: fall on outstretched hand with elbow extended.
Milch classification
type-I : fracture lateral to the trochlea and the joint is not involved and the
joint is stable.
type-II: the fracture pass through the trochlea and the joint is unstable.
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Clinical features:
Pain
Bruises over the lateral side of the elbow
Deformity
Passive flexion of the wrist may cause pain
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Treatment:
Undisplaced fracture: backslap with elbow flexed

90 degree and wrist extended for 2 weeks.
Displaced fracture: open reduction and internal

fixation by k-wires
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Non union of lateral condyle of elbow in children considered serious
complication because it may lead to cubitus valgus deformity and delayed
ulnar nerve palsy , that is why lateral condyle fracture in children is fracture
of necessity
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Pulled elbow ( subluxation of radial head)
It is subluxation of annular ligament from

the head of the radius into radiocapital
joint
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Clinical feature:
Pain and crying child of 2-3 years
history of the arm being jerked
The forearm locked in pronation
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Treatment
Dramatic response is achieved by forceful supination and
extension of the forearm with palpable snapping
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Appearance of ossification centers around elbow in children CRITOE
C2 y
R4y
I6y
T8y
O10y
E12y
DR-AHMED ABDALI 27
THANK YOU
DR-AHMED ABDALI 28

Elbow Dislocation DR - Ahmed Abdali

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Elbow Dislocation DR - Ahmed Abdali

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Injuries around elbow

 Loss of 3point configuration

Type-II: displaced single fragment

Type-III: comminuted radial head fracture

Radial head fracture

Treatment by open reduction

2. Indirect trauma by falling with forceful contraction of

Mechanism of injury: fall on outstretched hand with elbow extended.

Undisplaced fracture: backslap with elbow flexed

Displaced fracture: open reduction and internal

It is subluxation of annular ligament from

Pain and crying child of 2-3 years

history of the arm being jerked

The forearm locked in pronation

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