A.BALRAJ

Elbow dislocation

EPIDEMIOLOGYRare in children below 10 years of ageIncidence: 3-6 percentMales : 71 percent50 percent in children less than 20 years of

age

Mechanism of injuryFall on outstretched handEg. Sporting events and RTAPosterolateral dislocation is more common

Stimson classificationProximal RUJ Intact Proximal RUJ Disrupted

A.Posterior --posteromedial --posterolateral

A.Anteroposterior --radius is anterior --ulna is posterior

B.Anterior B.Medial Lateral (transverse) --radiius is lateral --ulna is medial

C.Medial

D.Lateral

Clinical features PainSwellingDeformityLoss of movementsNeurovascular injuries

Radiographs X-ray—AP and lateral view

Associated fractures in posterior dislocation of elbowMedial or lateral epicondylar fracturesCoronoid processRadial head fracture

Treatment Stimpson’s principles of closed reductionStep I—Traction along long axis of humerusStep II---Traction along long axis of forearm

Techniques of reduction Closed reductionOpen reduction

Closed reduction

Pusher’s techniquePushing force is applied to the tip of

olecranon with the thumb moreover,with the patient lying prone

Young children

Closed reduction

Older children young adolescents pulling force is applied to the forearm with elbow in 70* of flexion

Puller’s technique

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

Complication Neurovascular injuries

Complication Recurrent dislocationPathology Lax UCLPocket in RCLDefect in PL aspect of lateral condyleTreatment Surgery

Other complicationsProximal radio ulnar translationOsteochondral fracturesEctopic calcificationHeterotropic classificationUnreduced dislocations

Unreduced dislocations

Clinical features Fixed flexion deformityMuscle Wasting

Treatment Children : open reduction and resection of

myositis <3 months---OR>3 months---OR with arthroplastyAdults:Interpositional arthroplastyImplant arthoplastyResection arthroplasty

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