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

References:
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