Critical Cases - Elbow Dislocation!


  • 21 yo male presents after ground level fall, he landed on his outstretched R hand aka "FOOSH" (fall on outstretched hand)
  • He immediately felt pain at the elbow and heard a pop
  • He denies any numbness or weakness of the hand
  • Denies wrist or shoulder pain
  • Denies striking head or LOC, and has no HA or neck pain

Physical exam

  • HEENT: No evidence of trauma
  • C-spine: no tenderness to palpation
  • Pulm: Lungs clear
  • Cardio: No murmurs
  • Abd: Soft, nontender
  • Neuro: Intoxicated but otherwise no abnormalities
  • Extremities: obvious deformity of R elbow. No tenderness over R shoulder, able to abduct. No tenderness at wrist, normal flexion/extension, no snuffbox tenderness. Radial pulse is 2+, and cap refill is <2s in all digits


  • A FOOSH is a classic mechanism for many orthopedic injruies including: scaphoid fracture, scapho-lunate ligament injury, distal radius fracture aka "Colle's fracture," elbow dislocation if elbow flexed, humeral neck fracture, and others

Plain films:




Interpretation: Posterior dislocation of R elbow. No associated fractures



  • An intra-articular injection of 1/2 1% lidocaine 1/2 0.25% bupivicane was used for analgesia
  • See how to perform this invaluable technique here
  • Reduction was performed with in-line traction combined with supination and elbow flexion 
  • For a demonstration check out this video from the incomparable YouTube celebrity Dr. Mellick



Outcome and Teaching Points

Post reduction films:


Interpretation: Satisfactory reduction of elbow, no associated fractures

  • Post-reduction no neurovascular compromise noted
  • Patient placed in posterior long arm splint and sling
  • Discharged with instructions to follow with ortho in a week


  • Consider an intra-articular injection of local anesthestics as an alternative to the much more labor-intensive procedural sedation
  • Simple longitudinal traction with elbow in flexion is usually successful to reduce these injuries
  • Adding supination to traction may help with reduction
  • Be mindful of ancillary injuries at the wrist and shoulder with this type of injury