Case Report

ELBOW DISLOCATION

Eka Febiola C11113053 Ermita Sari C11113507

Reinaldy Basra C11113038 Patricia Purnama P. C11113508
Afkar Khalisa Y. C11111810 A. Besse Ummu C11113543
Fardyah C11112109

ADVISOR:
dr. Putra / dr. Sufandi

SUPERVISOR:
dr. A. Dhedie P. Sam, M.Kes, Sp.OT
 IDENTITY

Name : MA

Age : 12 years old /Boy

Admission : April 29th, 2018 at 01:00

Registration : 019512

Status : JKN

Phone Number : 0895360290949

 AUTOANAMNESIS

Chief Complain : Pain at right elbow

Suffered since 1 hour before admitted to Wahidin General
Hospital.
Patient fell down while climbing over a fence on an
outstretched right hand
History of decreased consciousness (-), vomit (-)
Patient is left hand dominant
 PRIMARY SURVEY

A : Clear

B : RR : 18x/min, symmetric, spontaneous, Thoracoabdominal type.

C : HR : 98 x/min, reguler, strong

BP : 100/60 mmHg

D : GCS 15(E4M6V5), light reflex +/+ , pupil isochors, Ø : 2.5mm/2.5mm

E : T = 36.70 C (axillary)
 SECONDARY SURVEY
Right Elbow Region
Look : Deformity (+), Swelling (+), Hematome (+),
Wound (-)
Feel : Tenderness (+)
Move : Active and passive movement elbow joint can not be
evaluated due to pain

NVD : Sensibility is good

Pulsation of Radial and Ulnar arteries are palpable
CRT < 2 seconds
Motoric : extend thumb (+); OK sign (+); Finger
Abduction (+)
CLINICAL FINDINGS
RADIOLOGY FINDING
RADIOLOGY FINDING
 LABORATORY FINDING
WBC 10.18 103/mm3
HGB 14.2 g/dL
HCT 45 %
PLT 278 103/mm3
HbsAg : Non- Reactive
BT : 3’00”
CT :8 ’00”
 DIAGNOSIS

Posterolateral dislocation of right

elbow joint
 MANAGEMENT

IVFD
Analgesic
Closed Reduction
Apply Dorsal Slab Above Elbow post reduction
 POST SLAB
Before After
POST REDUCTION
DISCUSSION
INTRODUCTION
 Elbow dislocations are the most common major joint dislocation
second to the shoulder

 Account for 10-25% of injuries to the elbow

 Posterior dislocation is the most common type of dislocation

 Annual incidence of elbow dislocations is 6-8 cases per 100.000

populations per year

 Highest incidences occurs in the 10-20 yrs old age group

ANATOMY
ANATOMY
ELBOW STABILITY

STATIC STABILIZERS (PRIMARY) DYNAMIC STABILIZERS MUSCLES

•ulnohumeral joint that cross the elbow joint, which apply
•anterior bundle of the MCL compressive (stabilizing) force
•LCL complex (includes the LUCL) • anconeus
• brachialis
STATIC STABILIZERS (SECONDARY) • triceps
•radiocapitellar joint
•joint capsule
•origins of the common flexor and extensor tendons Apley AG dan Solomon L. System of Orthopaedics and Trauma 10th Edition. Taylor & Francis Group. 201
MECHANISM OF INJURY
Most commonly caused by a fall onto an
outstretched hand or elbow

Posterior dislocation: This is a combination of elbow

hyperextension, valgus stress, arm abduction, and
forearm supination.

Anterior dislocation: A direct force strikes the posterior

forearm with the elbow in a flexed position.

Egot, Kenneth A. Handbook of fractures 5th Edition. Wolters Kluwer Health. 2015
CLASSIFICATION

Based on anatomic
description:
• Posterolateral (80-85%)
• Medial
• Lateral
• Anterior
• Divergent

Egot, Kenneth A. Handbook of fractures 5th Edition. Wolters Kluwer Health. 2015
CLASSIFICATION
Based on severity:
1. Simple
• elbow dislocation with no
associated fracture
• accounts for 50-60% of elbow
dislocations
2. Complex
• elbow dislocation with associated
fracture
• terrible triad injury
elbow dislocation, radial head
fracture, and coronoid tip fracture
• Child : avulsion of the medial
epicondyle
Egot, Kenneth A. Handbook of fractures 5th Edition. Wolters Kluwer Health. 2015
CLINICAL FINDING
Look:
• Assess for skin and tissue integrity
• Deformity
• Swelling
• Areas of ecchymosis
Feel:
• tenderness
• Warm
Move : Flexi, extensi, pronate,
supinate.
NVD:
• Examine neurovascular status
• Examine status of wrist and
shoulder
Egot, Kenneth A. Handbook of fractures 5th Edition. Wolters Kluwer Health. 2015
NEUROVASCULAR EXAMINATION
TREATMENT
NVD Examination
IMAGING
Radiographs
• AP and Lateral views
• Child : comparison
radiographs of the
contralateral

CT scan
Indication :
• Suspicion of complex injury
pattern
• Useful to identify associated
periarticular fractures
TREATMENT
Non Operative
Reduction and splinting at 90° for 7-10 days, early therapy
Indications acute simple stable dislocations

Reduction splinting in hinged brace at 90° for 2-3 weeks

Indications acute simple unstable elbow dislocations (unstable with
extension following reduction)

reduction maneuver
 inline traction to correct coronal displacement
 supination to clear the coronoid beneath trochlea
 flexion of elbow while placing pressure on tip of olecranon

assess post reduction stability

 elbow is often unstable in extension
 if LCL is disrupted then usually more stable in pronation
 if MCL is disrupted then usually more stable in supination
https://www.orthobullets.com/trauma/1018/elbow-dislocation
TREATMENT
Reduction Manuver
TREATMENT
Operative Technique

ORIF (coronoid, radial head, olecranon), LCL repair, and MCL repair
Indication:
• acute complex elbow dislocations
• persistent instability after reduction
• reduction cannot be performed closed

Open reduction, capsular release, and dynamic hinged elbow fixator

Indication:
• chronic dislocations

https://www.orthobullets.com/trauma/1018/elbow-dislocation
IMMOBILIZATION
• Splint in at 90° of elbow flexion
• Measure a plaster slab from the midhumerus to the
palmar crease, leaving the MCP joints free to flex

https://www.orthobullets.com/trauma/1018/elbow-dislocation
COMPLICATION
• Loss of motion
• Neurovascular injuries (ulnar/median nerves)
• Compartment syndrome
• Chronic instability
• Contracture/stiffness

https://www.orthobullets.com/trauma/1018/elbow-dislocation
PROGNOSIS

• The most common complaint in elbow dislocation was limited ROM

with a primary decrease in extension.
• The time of immobilization after reduction effect the ROM of elbow
• Recurrent instability occurs in less than 1–2% of simple elbow
dislocations

https://www.orthobullets.com/trauma/1018/elbow-dislocation
TREATMENT

https://med.unhas.ac.id/kedokteran/?cat=4&paged=6