Posterior Elbow Dislocation

• Posterior Dislocation:

  • most common dislocation in children and 2nd most common in adults
• Posterior Dislocation:

  • what
  • dislocation of the elbow joint +/- radial fracture +/- coronoid fracture
  • all 3 together forms the Terrible Triad
  • 90% of elbow dislocations posterior
  • where
  • the elbow joint (humeroulnar joint and humeroradial joint) and surrounding structures
  • how
  • falls make up 56% of incidences
  • generally a FOOSH (hyperextension + valgus)
  • sporting activities make up 44% of incidences
  • who
  • most common dislocation in children
  • 2nd most common dislocation in adults
  • highest incidence: males ages 10 to 19 years old
• Posterior Dislocation - Subjective Assessment:

  • caused by acute traumatic incidence - need to determine exact MOI and direction of fall as accurately as possible
  • determine level of instability - ask about clicking/clunking/feeling of instability
  • neurological symptoms - ask about neurological symptoms
• Posterior Dislocation - Objective Assessment:

  • observations
  • bruising - normally medially (lateral bruising indicates high grade injury)
  • deformities and swelling
  • palpation
  • tenderness of the medial and lateral structures
  • ROM
  • reluctance to move - indication of significant tissue injury
  • special tests
  • neurovascular assessment of the distal extremity
  • check collateral ligaments of elbow for compromise
  • investigations
  • xray: post injury, post reduction, 1 week post reduction
  • MRI: determines extent of soft tissue damage
• Posterior Dislocation - Management:

  • if its stable - conservative management
  • early reduction
  • analgesia
  • reduce swelling
  • early ROM
  • strength and return to function
  • if its unstable - surgical management
  • ORIF
  • radial head arthroplasty
  • ligament repair