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Definition: The dislocation of the elbow joint, where the upper arm骨 orbits the lower arm (radius) bone, resulting in an inability to straighten the elbow.
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Occurrence: Elbow dislocations are relatively common injuries, particularly in older children and adolescents, who often experience them during periods of physical activity or sports-related activities.
Incidence Rate of Elbow Dislocations in China according to to 2022 data (per 100,000 people)
18 cases per 100,000 people -
Etiology: This injury typically arises from a sudden, forceful movement that overwhelms the shoulder and elbow muscles and tendons, causing them to stretch or tear. This can occur due to a fall onto an outstretched hand, a hyperextension injury, valgus stress, or a supination injury.
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Pathology: Specifically, in posterolateral dislocations, the common flexor and extensor muscles that cross the elbow joint are unable to restrain the ulna from posterior subluxation relative to the radius. This leads to a posterior dislocation in which the olecranon process of the ulna moves posteriorly, and the coronoid process may also engage in a dislocation.
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Clinical Presentation: Patients with elbow dislocations typically present with intense, dull, or burning pain in the affected area, along with swelling and limited mobility. Physical examination may reveal a deformity in the affected elbow, such as a protrusion at the front or back of the elbow joint, and an increased thickness in the region of the elbow, due to increased fluid accumulation. Neurovascular assessment is crucial to detect any damage to adjacent blood vessels (such as the brachial artery) or nerves (such as the median nerve), which may be stretched over the displaced proximal fragment of the ulna.
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Imaging Findings: Plain radiographs of the affected elbow may show a dislocation with a "clunk" sound after reduction, indicating the reduction of ulnar nerve incarceration. Computerized tomography (CT) scans provide a more detailed view of the bones, including any fragments that may have been imprisoned during the dislocation.
CT scan images of an elbow dislocation -
Treatment: Treatment typically involves closed reduction, which involves gently pulling the elbow back into its normal position and holding it there with tape or a splint. After reduction, the elbow is commonly splinted in a position of 90 degrees of flexion for several days to allow for healing and reduce the risk of stiffness. Follow-up radiographs are obtained to confirm that the reduction is successful and that there are no associated fractures. In cases of complex dislocations with associated fractures or persistent instability, surgical intervention may be necessary, including open reduction and internal fixation (ORIF) with ligament repair orreplacement.
Open reduction process of an elbow dislocation -
Postoperative Care: After the procedure, the affected limb is usually splinted again in a flexion cast for another 5-7 days. The splint is then gradually removed as recovery progresses, allowing increased range of motion. Physical therapy is initiated within a few days of surgery to strengthen the surrounding muscles and regain lost mobility. Over time, with physiotherapy and exercise, most patients are able to regain a full range of motion.
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Complications: While most elbow dislocations can be successfully treated with conservative measures, there is a risk of complications, including stiffness in the affected joint, posterolateral joint instability, heterotopic ossification (abnormal bone formation), and occult distalsubluxation or distalsubluxation of the radiohumeral joint.
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Prognosis: With proper management and timely treatment, most patients can regain a functional and pain-free range of motion in their affected elbow. However, individuals with persistent instability or stiffness may experience persistent functional limitations and may require further surgical procedures to improve their condition.
It is important to note that the specific treatment plan for an elbow dislocation will depend on factors such as the severity of the injury, the position of the fracture, and the presence of any associated injuries. Patients should seek immediate medical attention for any suspected elbow dislocation to ensure timely and effective treatment.
