Download Elbow Dislocation

WARRAICH ROLL#17-C
Elbow Dislocation
Basics
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History of trauma.
Posterior dislocation is most common.
Age group : <20 years of age.
Rarely, elbow dislocation can occur in elderly
patients after a fall.
• Common site : ulnohumeral joint.
Classification (stimson)
Proximal radioulnar joint
intact:
Posterior (90%):
• Posterolateral
• Posteromedial
• Anterior
• Medial
• lateral
Proximal radioulnar joint
disrupted :
Anteroposterior
• Radius is anterior
• Ulna is posterior
Medial lateral:
• Radius is lateral
• ulna is medial
Treeible traid of the elbow :
• Posterior dislocation of elbow
• Radial head fracture
• Fracture of coronoid process of ulna
Pathophysiology
• The collateral ligaments usually are ruptured, with
injury to the brachialis muscle and coronoid.
Associated Conditions
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Fracture of the radius
Fracture of the ulna
Fracture of the humerus
Ulnar and median nerve injury
Brachial artery injury
Cont..
fig : complex dislocation of the elbow . In addition to
dislocation , there are multiple fracture of the elbow.
Cont…
• Nerve injury
Cont..
• Artery injuries :
Diagnosis
Signs and Symptoms
• The patient presents with :
• pain,
• swelling,
• elbow deformity, and
• inability to move the elbow.
Physical Exam
• Assess the patient's neurovascular status.
– Examine the functions of the radial, median, and ulnar
nerves before reduction.
• The median nerve can be injured at the time of reduction by
becoming entrapped in the joint.
• check nerve function before and after reduction.
– Evaluate the patient for brachial artery injury before
reduction.
• The brachial artery may be trapped in the joint along with the
median nerve.
• Vascular injury is an indication for immediate surgery.
Cont..
• Fig :
Cont..
• Artery injuries :
Exam..
• The upper extremity should be inspected for other
injuries, such as Monteggia fracturedislocation[fracture of the ulna with radial head
dislocation].
• Palpate the forearm for increased swelling or signs
of compartment syndrome
Tests
Imaging
• Radiography:
– AP : greater superimposition of distal humerus with
proximal ulna and olecranon is seen.
– lateral views : coronoid process lies posterior to the
condyles of the humerus
• CT (fracture pattern).
• MRI (ligamentous injury).
Treatment
General Measures • arm should be immobilized and elevated,
• Cryotherapy
• neurovascular status must be evaluated before and
after reduction.
• rules out associated fractures.
• closed reduction under general anaesthesia.
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Figure 42
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Performance of lateral pivot shift test,.
- holds the wrist and the elbow.
- The forearm is supinated, and a valgus stress is applied
- The “snap” noted by the patients can only be reproduced
under general anaesthesia; it occurs around 40° of elbow
flexion.
Con..
• fig
Figure 42 Performance of lateral pivot shift test,.
- holds the wrist and the elbow.
- The forearm is supinated, and a valgus stress is applied.
- The “snap” noted by the patients can only be reproduced
under general anaesthesia; it occurs around 40° of elbow
flexion.
Cont..
• fig
Figure 43 Performance of lateral pivot shift test on a
recumbent patient.
The arm is placed alongside the body, in full internal rotation.
The forearm is supinated, and axial compression and valgus
stress are applied as the elbow is moved from the fully
extended to a flexed position.
Surgery
• Surgery is indicated for:
– Irreducible dislocation
– Open dislocation
– Neurovascular entrapment
– Complex fracture dislocations
• Open reduction and internal fixation are
recommended for:
– Displaced radial head fractures
– Olecranon fractures
– Supracondylar humerus fractures
• Repair of complex fracture dislocations should be
based on restoring stability to the elbow.
– by repairing of the coronoid (if possible), restoration of
the radial head or radial head replacement, or repair of
the collateral ligaments.
Complications
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Neurovascular injury (ulnar – radial – median )
Recurrent dislocation
Arthritis
Myositis ossificans .
Cont..
• Fig: normal alignment after the elbow has been
reduced.
Cont..
• Fig :