What's the Diagnosis? By Dr. Sandhya Ashokkumar

 A 68 yo F presents to the ED s/p fall. She slipped walking up the steps and landed on her L side. She is complaining of severe L elbow pain. On exam, she has tenderness and a noted deformity of the L elbow. Neurovascular exam is intact. An xray is done and shown below. What's the diagnosis? (scroll down for answer)



Answer: Posterior Elbow Dislocation

  • Most common dislocation seen in pediatric patients, 2nd most common in adults
  • Requires significant amount of force
  • Mechanism: most commonly fall on outstretched hand
  • Classified as simple (without associated fracture) vs complex (with associated fracture)
  • Exam findings: forearm appears flexed and shortened, olecranon prominent posteriorly 
  • Associated injuries
    • Fractures: radial head, olecranon, and coronoid process
    • Neurovascular injuries: brachial artery, median nerve, ulnar nerve
  • Management:
    • Perfrom complete neurovascular assessment
    • Obtain AP, lateral, oblique films
    • Reduction
    • Long arm posterior splint with elbow in 90 degrees flexion
    • Orthopedic follow up in 1-2 days
    • Assocaited fractures, neurovascular compromise, joint instability, and open dislocations require emergent operative repair


Chow YC, Lee SW. Elbow and Forearm Injuries. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw-Hill