Treatment of simple elbow dislocations

Abstract

The elbow is the second most commonly dislocated joint. Elbow dislocations are often caused by falling onto an outstretched hand, resulting in application of a valgus, supinatory, and axially directed load to the elbow. Simple elbow dislocations are soft tissue injuries without an associated fracture. Multiple reduction techniques are described with the patient in both supine and prone positions. The definitive management of a simple elbow dislocation is primarily nonoperative with a splint for 7-10 days and active mobilization as soon as the splint is removed. This protocol minimizes complications such as a joint contracture and hastens a return to pre-injury activities. Surgical indications include a persistently unstable elbow, joint incongruency, and/or an open injury. Operative management may involve exploration, lateral ligament repair or reconstruction, and assessment of the need for medial ligament repair or reconstruction. Ulnar nerve transposition is not routinely performed. Joint contracture is the most common complication of an elbow dislocation, and other complications such as heterotopic ossification and neurovascular injury occur less frequently. Chronic instability after a simple elbow dislocation is very uncommon. The mechanism of injury, initial evaluation, imaging, and a treatment algorithm for these injuries will be reviewed.