What's the Diagnosis? By Dr. Erica Schramm

A 70 year old female with a history of osteoporosis presents after a trip and fall from standing. There is an obvious deformity of the left elbow posteriorly.  Pulses and sensation are intact distally.  A portable x-ray is shown below.  What's the diagnosis?  Scroll down for answer.

 

 

Diagnosis: Left elbow dislocation (posterolateral)

Mechanism:

-usually fall onto outstretched arm

-more common in children than adults

Classification:

-based on the position of olecranon relative to humerus

-posterior dislocation is the most common (approximately 80%)

-anterior, medial, lateral and divergent dislocations are less common

Possible associated injuries:

- fracture (most commonly of coronoid process, radial head or medial epicondyle)

- neurovascular (entrapment of the brachial artery, median nerve, ulnar nerve, or radial nerve)

                -brachial artery and ulnar nerve are the most common

-ligamentous injuries (MCL, LCL, etc.)

Closed reduction and techniques:

-posterior dislocation (two person technique, see image below)

-with the patient supine, an assistant applies counter traction on the upper arm while you apply longitudinal traction to the wrist and forearm with one hand while correcting any medial or lateral displacement with the other hand (A)

-then apply downward pressure on the forearm to disengage the coronoid process

-flex the elbow until you hear a pop and feel the olecranon fall into place (B)

 

-splint in long arm posterior splint with the elbow in 90 degrees of flexion and the forearm in slight pronation, do not circumferentially cast due to high risk of edema

 

 

 

Indications for open reduction and fixation:

-unstable joint after closed reduction

-closed reduction failed

-associated with coronoid and/or radial head fractures

-open fracture/dislocation

-neurovascular compromise

 

References:

Campen, Angelique.  "Elbow Joint Dislocation Reduction."  Reichman's Emergency Medicine Procedures, 3e Ed. Eric F. Reichman. New York, NY: McGraw-Hill, 2018.

 

Chow, Yvonne C.. "Elbow and Forearm Injuries." Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016.