Review Question - QID 4543

The clinical presentation is consistent with a simple elbow dislocation. Initial management should include closed reduction, splinting or sling placement for comfort and early active ROM exercises.

Simple elbow dislocations should be reduced and treatment guided by the relative stability of the joint during the arc of motion. The elbow should be splinted where it is most stable. After 5-7 days the splint can be discontinued and active ROM started to apply compressive stability to the joint. A hinged brace with an appropriate extension block can facilitate motion through the stable arc.

Armstrong discusses pathomechanics and basis for treatment in simple elbow dislocations. She emphasizes delineating the arc through which the elbow is stable and using this to guide initial management. Early surgical management may be warranted when the elbow is unstable with 60 degrees or more of flexion.

Josefsson et al. studied 30 patients who had sustained simple elbow dislocations and prospectively randomized the patients into non-operative and operative study arms. Operative intervention included reattachment of avulsed ligaments/muscles from the distal humerus. They found no statistical difference in clinical outcomes between the groups regardless of the severity of the instability.

Figure A demonstrates a clinical photo of a patient having sustained an elbow dislocation. Figure B is a radiograph demonstrating a posterolateral elbow dislocation, which is named based on the direction that the ulna/radius move relative to the humerus. Illustration A is a video that reviews the pathomechanics of elbow dislocations.

Incorrect Answers
Answer 1, 2: While use of a hinged external fixator may be appropriate when instability persists after repair/reconstruction of the LCL complex, it is not the first step in the initial management of a simple elbow dislocation.
Answer 3: Open reduction may be warranted if closed reduction is unsuccessful, however an initial attempt at conservative measures should be made.
Answer 4: Closed reduction needs to be followed by splinting to give the tissues a chance to recover from the initial injury; use of ACTIVE range of motion exercises early, will help to provide dynamic compressive stability to the joint.