How Do I Treat an Elbow Dislocation?

Elbow dislocation is a common elbow injury that occurs in adolescents, as well as in adults and children. Due to the more complex types of elbow joint dislocations, it is often associated with severe injuries to other bone structures or soft tissues of the elbow, such as humeral epicondyle fractures, ulna olecranon fractures, and coronal process fractures, as well as injuries to the joint capsule, ligaments, or vascular nerve bundles. Most are posterior or posterolateral dislocations of the elbow joint.

Basic Information

English name: dislocation of elbow joint
Visiting department: orthopedics
Multiple groups: teens

Common causes: Elbow dislocation is mainly caused by indirect violence
Common symptoms: Swelling and pain, joints placed in a semi-flexed state, blood vessels with restricted extension and flexion movements, and symptoms and signs related to nerve damage, etc.

Causes of elbow dislocation

Elbow dislocation is mainly caused by indirect violence. The elbow is a connection structure between the forearm and the upper arm. The transmission of violence and leverage are the basic external force forms that cause dislocation of the elbow joint.

Posterior elbow dislocation

This is the most common type of dislocation, with adolescents as the main target. When the fall, the palm touched the ground, the elbow joint was fully extended, and the forearm was in a supine position. The elbow joint was overextended due to the gravity of the human body and the ground reaction force. External forces continued to strengthen, causing tears in the anterior portion of the anterior brachial muscle and the elbow joint capsule attached to the coracoid process, causing the ulna olecranon to shift backwards, and the lower humerus forward to displace the elbow joint. Because the inner and outer condyles of the lower end of the humerus that constitutes the elbow joint are wide and thick, and are flat and thin before and after, there are collateral ligaments on the side to strengthen its stability.

2. Anterior elbow dislocation

Anterior dislocations are rare and often associated with ulna olecranon fractures. The cause of the injury is mostly direct violence, such as direct external force after the elbow or impact of the elbow on the ground in the flexed position, resulting in olecranon fracture and proximal dislocation of the ulna. This kind of damage to the elbow soft tissue damage is more serious, especially vascular and nerve damage is common.

3. Lateral dislocation of elbow joint

Most common among teenagers. When the elbow is subjected to conductive violence, the elbow joint is in the varus or eversion position, causing the lateral collateral ligament of the elbow joint and the joint capsule torn. The lower end of the humerus can be moved to the radial or ulnar side (that is, the joint capsule rupture). Bit. Due to the strong varus and eversion, the humeral internal and external condylar avulsion fractures are caused by the violent contraction of the forearm extension or flexor muscle group, especially the humeral epicondyle is more prone to fracture. Sometimes fractures can be embedded in the joint space.

4. Split and dislocation of elbow joint

This type of dislocation is rare. When the upper and lower conductive violence were concentrated on the elbow joint, the forearm was overpronated, the annular ligament and the proximal interosseous membrane of the ulna and radius were split, causing the radial head to be dislocated forward, and the proximal ulna was dislocated backward. The lower end of the humerus is inserted between the two bone ends.

Clinical manifestations of dislocation of elbow joint

Elbow swelling and pain, joints placed in a semi-flexion, limited extension and flexion movements. If the elbow is dislocated, the back of the elbow is empty, and the hawk's mouth is obviously protruding backwards; the lateral dislocation, the elbow is deformed with varus or eversion of the elbow. The elbow socket is full. The relationship between the inverted isosceles triangle formed by the humerus inner and outer condyles and the beak was changed. When dislocation of the elbow joint, pay attention to the symptoms and signs of blood vessel and nerve injury.

Elbow dislocation examination

Routine X-ray examination can obtain a preliminary diagnosis, and CT and 3D reconstruction can obtain accurate fracture and dislocation information.

Diagnosis of elbow dislocation

X-ray examination can confirm the diagnosis and is an important basis for judging the type of joint dislocation and the condition of combined fracture and displacement. CT and three-dimensional reconstruction have important functions in judging the disease, confirming the diagnosis and surgery.

Elbow Dislocation Treatment

Non-surgical treatment

The main treatment for dislocation of fresh elbow joint or dislocation with fracture is manual reduction. For some old fractures, manual reduction can be tried first. Simple elbow dislocation. Take a seated position and apply local or brachial plexus anesthesia. If the injury time is short (within 30 minutes), anesthesia may not be applied. Ask the assistant to hold the upper arm of the affected limb with both hands, and hold the wrist tightly with both hands. The elbow is flexed by 60 ° ~ 90 ° with traction, and the pronation can be heard a little or the vibration of resetting is often heard. After reduction, the elbow joint was fixed in functional position with upper limb plaster. After 3 weeks, remove the plaster and do active functional exercises, supplemented with physical therapy if necessary, but not strong passive activities.

Dislocation of the elbow joint with avulsion of the epicondyle of the humerus: The reduction method is basically the same as that of the simple dislocation of the elbow. When the elbow is reset, the epicondyle of the humerus can usually be reset. If the fracture piece is embedded in the joint cavity, when the upper arm is pulled, the elbow joint is abducted (valgus), so that the medial space of the elbow joint is enlarged, and the medial epicondyle avulsion bone piece is pulled by the forearm flexors The joint was released and reset. If the fracture piece is out of the joint, it can still be reduced by manual operation when it is displaced, and pressurized when the plaster is fixed. There is also a button-like incarceration that cannot be reset, and surgical incisions should be considered.

Old dislocation of the elbow joint (early stage): older than 3 weeks will be considered as old dislocation. It usually feels difficult to reset after 1 week. Intra-articular hematomas, granulation tissue formation, joint capsule adhesions, etc. Reset the old dislocation of the elbow joint. Under brachial plexus anesthesia, perform gentle extension and flexion of the elbow to gradually loosen its adhesion. The elbow is slowly extended, and the elbow is gradually flexed under the action of traction. The surgeon presses the eagle's mouth with the thumbs of both hands and pushes the lower end of the humerus backward to reset it. After the X-ray film confirmed that it had been reset, the elbow joint was fixed slightly <90 ° with upper limb plaster, and the plaster was removed for functional exercise in about 3 weeks.

2. Surgical treatment

(1) Indications for surgery Those who fail closed reduction or are not suitable for closed reduction. This is rare and often involves severe elbow injuries, such as fractures of the olecranon and separation and displacement; dislocation of the elbow joint with humerus The epicondyle avulsion fracture is reduced. When the dislocation of the elbow joint is reduced and the internal epicondyle of the humerus is still not restored, surgery should be performed to restore or fix the internal epicondyle; Some habitual elbow dislocations.

(2) Open reduction Brachial plexus anesthesia. A longitudinal incision was made after the elbow, and the posterior side of the medial epicondyle of the humerus was exposed and protected the ulnar nerve. The triceps tendon is made a tongue incision. After the elbow joint is exposed, the surrounding soft tissue and scar tissue are stripped to remove the hematoma, granulation and scar in the joint cavity. Distinguish the joint-bone relationship and reduce it. Suture the tissue around the joint. To prevent further dislocation, a Kirschner wire can be used to fix from the eagle's mouth to the lower end of the humerus, and it is removed after 1 to 2 weeks.

(3) Arthroplasty is mostly used for those with dislocated elbow joints, damaged cartilage surface, or stiffened joints after elbow injury. Brachial plexus anesthesia. Take a posterior elbow incision and cut the triceps tendon. Exposed the ends of the elbows. The lower end of the humerus was excised, and a part of the inner and outer condyles of the humerus was retained. The top and part of the dorsal bone of the olecranon process are removed, and the tip of the coracoid process is also cut smaller to preserve the articular cartilage surface. The radial head may not be removed unless it affects joint activity, otherwise the radial head is removed. According to the newly formed joint space, if the stenosis is narrow, the central part of the lower end of the humerus can be appropriately removed by 0.5 cm, and it is bifurcated. The ideal gap distance should be 1 ~ 1.5cm.

Arthroplasty with a wide fascia between the joints has a good effect on the bony stiff elbow. Note that when lining the broad fascia as the articular surface and the joint capsule, the deep fascia should face the joint cavity side. After lining the broad fascia on the articular surface, check the wound, align the elbow joints, and observe In some cases, the wound is sutured layer by layer. The elbow joint was fixed at 90 ° with the upper limb plaster support after operation, and the forearm was fixed at the pronation and supination position. Raise the injured limb and move your fingers. After a few days, bring the upper limb plaster support to perform functional exercises, remove and fix about 3 weeks, strengthen the injured limb functional exercises, and supplement with physical therapy.