The elbow is inherently subjected to dislocations because of
its mechanical structure.1 Elbow dislocations are one of
the more common joint dislocations in the body, second only to dislocations
of the shoulders and fingers.2 Injuries to the elbow have
a high potential for complications and residual disability.3 Timely
reduction is imperative to relieve pain and reduce the possibility
of neurovascular sequelae.3 Closed reduction of the elbow
is unlikely to be successful if not performed promptly.4
The most common mechanism for a dislocation is a fall onto an
extended and abducted arm. The patient usually presents with a swollen
and painful arm that is held in flexion. Elbow dislocations require
a significant amount of force. Up to 20 percent of elbow dislocations
are associated with fractures.2 Simple elbow dislocations
have a better prognosis and are less likely to require surgical
intervention than complex ones (fracture-dislocations). This chapter
deals with the closed reduction of simple elbow dislocations.
One particular type of dislocation pertains primarily to the
pediatric population. Subluxation of the radial head, often referred
to as a “nursemaid’s elbow,” occurs commonly
in preschool children. It is rarely seen after age 7 and represents
20 percent of upper extremity injuries in children.5 It
occurs after sudden traction on the radius with an extended elbow,
as when an adult pulls a child up into a standing position by one
arm. The annular ligament slips between the capitellum and the head
of the radius, impeding supination of the arm. The patient will
present with the arm held in slight flexion and pronation, usually
in not much distress, and not using the affected arm. The simple
reduction of this dislocation is also addressed.
The elbow is a hinge joint comprising articulations between the
humerus, the ulna, and the radius (Figure 68-1). The distal humerus
consists of the extraarticular medial and lateral epicondyles, which
are diverging columns separated by the intraarticular trochlea and
capitellum. The trochlea articulates with the proximal ulna. The
articular surfaces of the trochlea extend from the coronoid fossa
anteriorly to the olecranon fossa posteriorly. The anterior and
posterior fossae provide space for the coronoid and olecranon, respectively,
at the extremes of motion. The capitellum is a spherical structure
that articulates with the concave radial head.
Bony anatomy of the elbow region. The right arm is demonstrated
in these illustrations. A. Anterior
view. B. Posterior view. C. Posterior view of the elbow in 90
degrees of flexion. D. Lateral view
of the elbow in 90 degrees of flexion.
Numerous neurovascular structures cross the elbow (Figure 68-2).
The prominent medial epicondyle protects the ulnar nerve, which
travels in its posterior sulcus. The radial nerve travels just anterior
to the lateral epicondyle. The median nerve travels with the brachial
artery through ...