ELBOW

DISLOCATIONS

Joints of the ElbowJoints of the Elbow

• Hinge jointHinge joint• Composed of 3 articulations:Composed of 3 articulations:

1. Humeroulnar joint1. Humeroulnar joint

2. Humeroradial joint2. Humeroradial joint

3. Radioulnar joint3. Radioulnar joint

The Elbow JointThe Elbow Joint

Ligaments of the ElbowLigaments of the Elbow

Ulnar Collateral LigamentUlnar Collateral Ligament

medial side – connects humerus to ulnamedial side – connects humerus to ulna

Radial Collateral LigamentRadial Collateral Ligament

Lateral side – connects humerus to radiusLateral side – connects humerus to radius

Annular LigamentAnnular Ligament

Surrounds radial head/holds it tight Surrounds radial head/holds it tight

to ulnato ulna

Elbow DislocationsElbow Dislocations

• 20% of all dislocations20% of all dislocations• Second most commonly dislocated majorSecond most commonly dislocated major

joint of the body behind the shoulderjoint of the body behind the shoulder• Associated fracturesAssociated fractures• – – Radial head/neck 50-60%Radial head/neck 50-60%• – – Medial/lateral epicondyle 10%Medial/lateral epicondyle 10%• – – Coronoid process 10%Coronoid process 10%

Elbow dislocationElbow dislocation

• Usually fall on the Usually fall on the wrist or hand with wrist or hand with the elbow in the elbow in extension.extension.

• Severe pain at Severe pain at elbow and swellingelbow and swelling

• Minimal movementMinimal movement

classificationclassification

Clinical featuresClinical features

Severe pain at the elbow

Triceps tendon stands prominent(bowstringing of triceps)

The 3 bony-points relationship is reversed

Associated median nerve palsy

Diagonosis is often confirmed on X-rays

X-RAYS

Posterior dislocation of elbow

Medial dislocation of elbow

Divergent dislocation of elbow

Dislocation of the RadiusDislocation of the Radius

• The radial head may be displaced The radial head may be displaced forward, backward, or outwardforward, backward, or outward

• Children under 5 are prone to Children under 5 are prone to subluxation of the radial head due to subluxation of the radial head due to a “pulling” on the forearm a “pulling” on the forearm

Pulled elbow or Nursemaid’s armPulled elbow or Nursemaid’s arm

TreatmentTreatmentIt is by reduction under anaesthesia followed by immobilisation in an above-elbow plaster slab for 3 weeks

complicationsElbow stiffness

Myositis

Injury to brachial artery and median nerve

Compartment syndrome

Fracture of head of radius & coronoid process

Fracture & entrapment of medial epicondyle

heterotropic ossification (formation of bone where it is usually not seen as in muscles and fascia).