summary Elbow Dislocations are common elbow injuries which can be characterized as simple or complex depending on associated injury to nearby structures. Diagnosis can be made with plain radiographs. CT studies can be helpful to evaluate for loose bodies or for surgical planning. Treatment is closed reduction followed by a short period of immobilization for stable simple elbow dislocations. Surgical management is indicated for complex elbow dislocations associated with fractures or persistent instability. Epidemiology Incidence elbow dislocations are the most common major joint dislocation second to the shoulder most common dislocated joint in children account for 10-25% of injuries to the elbow posterolateral is the most common type of dislocation (80%) Demographics predominantly affects patients between age 10-20 years old Etiology Pathophysiology mechanism for posterolateral dislocation usually a combination of login to view 3 more bullets a varus posteromedial mechanism (combined with axial load and forearm external rotation) has also been reported posterior dislocations may involve more than one injury mechanism pathoanatomy associated with complete or near complete circular disruption of capsuloligamentous stabilizers pathoanatomic cascade login to view 5 more bullets Associated injuries shoulder and wrist injuries concomitant shoulder and wrist injuries occur in 10-15% of elbow dislocations Anatomy Osteology static and dynamic stabilizers confer stability to the elbow static stabilizers (primary) login to view 3 more bullets static stabilizers (secondary) login to view 3 more bullets dynamic stabilizers login to view 4 more bullets See complete Anatomy and Biomechanics of Elbow Classification Anatomic based on anatomic location of olecranon relative to humerus posterolateral login to view 1 more bullet posteromedial Simple vs. complex simple elbow dislocation with no associated fracture accounts for 50-60% of elbow dislocations complex elbow dislocation with associated fracture may take form of login to view 9 more bullets Presentation Symptoms pain and swelling Physical exam inspection the status of the skin - evaluate for open injuries palpation presence of compartment syndrome status of wrist and shoulder login to view 1 more bullet neurovascular status Imaging Radiographs recommended views AP and lateral views login to view 1 more bullet oblique views login to view 1 more bullet CT scan indications suspicion of complex injury pattern useful to identify associated periarticular fractures Treatment Nonoperative closed reduction and immobilization with early motion indications login to view 2 more bullets techniques splint in at least 90° of flexion for 5-10 days begin early supervised physical therapy Operative open reduction internal fixation (ORIF) with ligament repair indications login to view 5 more bullets technique login to view 5 more bullets open reduction, capsular release, and dynamic hinged elbow fixator indications login to view 1 more bullet postoperative login to view 1 more bullet Technique Closed reduction and immobilization with early motion closed reduction technique login to view 10 more bullets immobilization place post-reduction posterior mold splint in flexion and appropriate forearm rotation login to view 3 more bullets post-reduction radiographs obtain following reduction in immobilization login to view 2 more bullets rehabilitation initial login to view 2 more bullets early login to view 3 more bullets late rehabilitation login to view 1 more bullet Open reduction internal fixation (ORIF) with ligament repair approach approach depends on the location of the pathology login to view 7 more bullets posterior approach internal fixation with ligament repair coronoid fractures login to view 3 more bullets radial head fractures login to view 8 more bullets LCL login to view 2 more bullets MCL login to view 1 more bullet postoperative elbow requires >50-60° to maintain reduction depending on stability of the elbow, active ROM exercises may commence while using a brace an extension block may or may not be used Hinged external fixator only necessary if elbow remains unstable after attempt at fixation as described above Complications Early stiffness loss of terminal extension is the most common complication after closed treatment of a simple elbow dislocation early, active ROM can help prevent this from occurring static, progressive splinting can be helpful after inflammation has decreased often between 6-8 weeks after surgery Varus posteromedial instability injury to the LCL and fracture of the anteromedial facet of the coronoid solid fixation of the anteromedial facet is critical for functional outcome and prevention of arthrosis Neurovascular injuries brachial artery injuries (rare) typically associated with open dislocations ulnar nerve injury typically results from stretch median nerve injury (rare) typically associated with brachial artery injury Compartment syndrome Damage to articular surface Recurrent instability Heterotopic ossification may require excision to improve elbow range of motion Contracture/stiffness correlated with immobilization beyond 3 weeks