1. WARRAICH ROLL#17-C Elbow Dislocation Basics
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.

3. 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

4. Treeible traid of the elbow :
Posterior dislocation of elbow
Radial head fracture
Fracture of coronoid process of ulna

5. Pathophysiology
The collateral ligaments usually are ruptured, with injury to the brachialis muscle and coronoid.

6. Associated Conditions
Fracture of the radius
Fracture of the ulna
Fracture of the humerus
Ulnar and median nerve injury
Brachial artery injury

7. Cont..
fig : complex dislocation of the elbow . In addition to dislocation , there are multiple fracture of the elbow.

8. Cont…
Nerve injury

9. Cont..
Artery injuries :

10. Diagnosis Signs and Symptoms The patient presents with : pain,
swelling,
elbow deformity, and
inability to move the elbow.

11. Assess the patient's neurovascular status.
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.

12. Cont..
Fig :

13. Cont..
Artery injuries :

14. Exam..
The upper extremity should be inspected for other injuries, such as Monteggia fracture-dislocation[fracture of the ulna with radial head dislocation].
Palpate the forearm for increased swelling or signs of compartment syndrome

15. Tests Imaging Radiography: CT (fracture pattern).
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).

16. 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.

17. . - 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.
. -

18. 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.
fig

19. Cont..
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.
fig

20. Surgery Surgery is indicated for: Irreducible dislocation
Open dislocation
Neurovascular entrapment
Complex fracture dislocations

21. 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.

22. Complications Neurovascular injury (ulnar – radial – median )
Recurrent dislocation
Arthritis
Myositis ossificans .

23. Cont..
Fig: normal alignment after the elbow has been reduced.

24. Cont..
Fig :