Elbow Dislocation

In an elbow dislocation the forearm bones (ulna and radius) are pushed out of line with the upper arm bone, in nine cases out of ten backwards. It is the second most commonly dislocated large joint in adults and the most common in children. A simple dislocation has ligament injury only. A complex dislocation comes with fractures, most seriously the terrible triad of radial head fracture, coronoid fracture and ligament rupture.

Simple dislocations usually do well without surgery once the joint is reduced, provided movement starts early. The elbow's characteristic problem afterwards is stiffness, not looseness: some permanent loss of the last 10 to 15 degrees of straightening is common and rarely limits daily life. Complex injuries generally need an operation to restore stability.

Symptome

• Severe elbow pain after a fall onto an outstretched hand
• Obvious deformity with the point of the elbow prominent at the back
• The arm held slightly bent and unable to move
• Rapid swelling
• Numbness or tingling in the little and ring fingers (ulnar nerve) or thumb side (median nerve)
• A pale, cold hand or weak pulse at the wrist

Ursachen und Risikofaktoren

The typical mechanism is a fall onto an outstretched hand with the elbow slightly bent, which levers the joint open from the outer side. It occurs in gymnastics, wrestling, skating, cycling, football and in falls from height or road accidents. In young children a sudden pull on the hand causes a pulled elbow (nursemaid's elbow), where the radial head slips partly under its ligament; this is a much milder injury and is corrected with a simple manoeuvre.

Wie es diagnostiziert wird

• Neurovascular examination: Pulse, colour and nerve function in the hand are recorded before and after reduction.
• X-rays: Front and side views confirm the direction and show associated fractures; they are repeated after reduction to confirm the joint sits concentrically.
• CT scan: Defines radial head and coronoid fractures in complex injuries and guides surgical planning.
• Stability testing after reduction: The elbow is moved through its range to find the angle at which it tends to slip, which sets the safe zone for early movement.
• MRI: Occasionally used to assess ligaments in persistent instability.

Behandlungsmöglichkeiten

• Closed reduction under sedation: Gentle traction and flexion restore the joint, usually in the emergency department.
• Brief splinting: A sling or splint at about 90 degrees for 5 to 10 days at most.
• Early protected movement: Active exercises within the stable range, sometimes in a hinged brace, begun within 1 to 2 weeks to prevent stiffness.
• Surgery for complex dislocations: Fixation or replacement of the radial head, coronoid fixation and repair of the lateral ligament complex.
• Ligament reconstruction: Tendon graft reconstruction for chronic recurrent (posterolateral rotatory) instability.
• Surgical release of stiffness: Arthroscopic or open release, and removal of extra bone that has formed, if movement remains poor after 6 to 12 months.

Wenn es dringend ist

An elbow dislocation needs an emergency department straight away. Tell staff immediately about numb fingers or a cold, white hand. After reduction, increasing pain with a tense forearm and pain on stretching the fingers may mean compartment syndrome and is also an emergency.

Reisen nach Türkiye zur Behandlung

The initial reduction is always local. A trip can be considered for the later consequences: a stiff elbow that has not responded to 6 months of therapy, extra bone blocking movement, persistent instability, or a complex fracture dislocation that healed poorly. These are planned operations with around 7 to 10 days on site, and results depend heavily on daily physiotherapy for several months afterwards, so have that arranged at home first.

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