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% 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% 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 82-1). 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° of flexion. D. Lateral view of the elbow in 90° of flexion.
Numerous neurovascular structures cross the elbow (Figure 82-2). 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 the antecubital fossa.