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m


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Ê The elbow joint, although a single
synovial cavity, is made up of three
distinct articulations, which are:
Ê ã

  between the
trochlea of the humerus and the
trochlear notch of the ulna (a hinge-
joint);
Ê m 



 between the
capitulum and the upper concave
surface of the radial head (a ball and
socket joint);
Ê ›  

 between
the head of the radius and the radial
notch of the ulna, the head being
held in place by the tough annular
ligament (a pivot joint).

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Ê The capsule of the elbow joint is closely applied around this
complex articular arrangement; the non-articular medial and
lateral epicondyles are extracapsular.
Ê The capsule is thin and loose anteriorly and posteriorly to
allow flexion and extension, whereas it is strongly thickened
on either side to form the medial(ulnar) and lateral (radial)
collateral ligaments.

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Two sets of movements take
place at the elbow
ã  
  
at the humero-ulnar and
humero-radial joints

m 


 
at the proximal radio- ulnar
and distal radio-ulnar joint.

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¡

  ¡

Ê 
ormal : 0-145 degrees
Functional : 30-130 degrees

Ê  
ormal-80 degrees each way
Functional  is 50 degrees each way

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² 
 

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Ê m0% of all dislocations
Ê Essentially a Humero-ulnar dislocation
Ê
econd most commonly dislocated major joint of the
body after the shoulder
Ê mssociated fractures
Ê Ȃ adial head/neck 50-60%
Ê Ȃ edial/lateral epicondyle 10%
Ê Ȃ Coronoid 10%

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 ¡

 
Ê ˜sually indirect voilence (Posterior dislocation).
Ê ess commonly its direct voilence (mnterior Dislocation).
Ê m patient of any age can dislocate his elbow if he falls on
his outstretched hand.
Ê In this common injury a force travels up his forearm and
pushes his radius and ulna posteriorly, or his humerus
posteriorly and laterally.

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 ¡ m

Ê Patient cannot move his elbow, and usually holds it at
about 45.
Ê The posterior outline of his elbow, instead of being
normally rounded, shows a prominent pointed
projection backwards .
Ê The three bony points of the elbow are not in their
normal places.
Ê There may be other injuries also:
Ê (1) m child may fracture his medial epicondyle which
may become trapped inside his dislocated elbow.
Ê (m) His lateral condyle may also fracture.

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¡ m


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Classified according to the position of the radius and ulna in relation
to the distal humerus after injury.
! "
Ê Posterior (most common)
Ê mnterior
Ê edial
Ê ateral
Ê Divergent (radius and ulna are dislocated in different directions in
relation to humerus).

mll these varieties may be complex or simple. Complex dislocations

are associated with fractures whereas simple ones are pure
dislocations without fractures.

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 ²

 
Ê The patient presents with # $% 

&" around the
elbow. The affected extremity is supported with the opposite hand due
to pain.
Ê The &


 
  and the '
    
on the posterior aspect of the elbow.
Ê The 
 (') 
$
 
 
 between the
epicondyles of the humerus and the olecranon is disturbed.
Ê m careful examination of the brachial artery and the peripheral nerves
is essential to  
!
'
  *"
Ê +# 
+" 
 +
 after a successful reduction has
been achieved.
Ê Proper X-rays (mP and lateral) should be requested to confirm the
diagnosis and to identify associated injuries.

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 m 

 

Ê Fracture of the radial head,
Ê Fracture of the coronoid process
Ê Fracture of the ulna
Ê Fracture the medial epicondyle.
Ê upture of edial collateral ligament
Ê upture of lateral collateral ligament
Ê mssociated onteggia fracture type IV

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Ê mT

Ê Injury specific treatment
Ê est and support
Ê eassure
Ê elief of pain
Ê Investigations
Ê Proper management

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 ¡





Dislocation eduction:
Ê ˜rgently
Ê Closed method (98%)
Ê pen ethod (m%)
Ê mssociated injuries management

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 "


Ê The sooner you do this, the easier it will be, and the fewer the
complications
Ê Good general relaxation is essential in adults, but is less
necessary in children.
Ê XȂ m
Check: (1) that reduction is satisfactory, and (m) that
there is no bony fragment trapped in the joint. If there is, it will
have to be removed by opening the joint.

Ê Cm˜TI if you neglect to XȂray a patient after trying to reduce

his dislocated elbow, you may fail to diagnose that reduction is
incomplete, until after the swelling has gone. eduction will
then be possible only at open operation with irepairable
damabge been done to the elbow articular surface already

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Ê The patient lies on his back with his upper arm vertical, and
his forearm flexed across his chest.
Ê mssistant will exert traction on the patientǯs hand from the
other side of the table .While he does this, grasp the patientǯs
elbow in both hands, with your fingers round the front of his
humerus, and your thumbs behind his olecranon.
Ê The patientǯs olecranon should lie in the centre of his arm
midway between his two epicondyles . If it is shifted sideways,
first move it into the midline with your thumbs as you reduce
it, then push it forwards over the lower end of the
humerus,and at the same flex the elbow gradually .
Ê The dislocation will reduce with a scrunch.When you think
that you have succeeded, move the patientǯs elbow through its
normal range. ˜nless you can get full flexion, you have not
reduced it. If it feels stable, apply a plaster back slab

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mlways remember after reduction:
Ê Check adial pulse
Ê Check full regaining of normal 
Ê Check re-establishment of Bony triangular
configuration
Ê adiological evaluation
Ê Plaster support.
Ê ms soon as a patient recovers from the anesthetic, re-
examine his median, ulnar, and radial nerves to make
sure that you have not injured them during reduction

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& ' 
+
Ê rest his arm in a sling for 3 weeks in the hope of avoiding postȂ
traumatic ossification. While it is in the sling he should move it as much
as possible.
Ê
tart shoulder, finger, and wrist exercises within the sling immediately.
Ê If there are no complications, his elbow will recover slowly, but he may
always have some limitation of full extension.
Ê ever perform passive stretching exercises. These encourage postȂ
traumatic ossification.

& '  

+
Ê flex his elbow as far as it will go in a collar and cuff sling, or with a
posterior slab, for 3 weeks.
Ê Then start active movements.

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Ê oss of 
Ê ecurrent dislocations.
Ê Heterotopic ossification.(yositis ssificans)
Ê Post-traumatic osteoarthritis.

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