Critical Cases - Elbow Dislocation!
Tue, 05/18/2021 - 8:14am
Editor:
History
- 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
Ddx:
- 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
Management
- 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
Tips:
- 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