Overview
Open fracture dislocation of the elbow joint involves both dislocation and bone fractures, complicating the management and prognosis compared to isolated dislocations. 13Diagnosis
Clinical Presentation: Acute trauma with pain, deformity, and limited range of motion.
Physical Examination: Assess for neurovascular compromise, joint congruity, and associated fractures.
Imaging: X-rays essential for confirming dislocation and identifying fractures; CT may be needed for complex injuries.
Arterial Assessment: High suspicion for brachial artery injury in open dislocations; Doppler ultrasound or angiography if indicated. 3Management
Emergency Reduction: Under sedation or general anesthesia to avoid complications.
Immobilization: Initial antalgic immobilization followed by active mobilization. 1
Surgical Intervention: Consider for complex dislocations, ligament injuries, or open fractures requiring surgical fixation.
Arterial Repair: Immediate surgical repair if brachial artery transection is suspected or confirmed. 3
Arthroscopic Repair: For high-demand patients with simple dislocations, arthroscopic repair of radial ulnohumeral ligament can be considered to optimize functional outcomes. (Evidence: Moderate) 2Special Populations
Pediatrics: Transverse divergent dislocations may recover well with closed reduction and immobilization. 7
Elderly: Increased risk of associated fractures and comorbidities; careful assessment and individualized treatment plans are crucial. 14
Comorbidities: Presence of vascular injuries necessitates urgent vascular surgery alongside orthopedic management. 3Key Recommendations
Perform emergency reduction under anesthesia to prevent complications and ensure proper alignment. (Evidence: Moderate) 1
Initiate vascular assessment and immediate repair if brachial artery injury is suspected in open dislocations. (Evidence: Weak) 3
For high-demand patients, consider arthroscopic repair of ligaments to enhance functional recovery. (Evidence: Moderate) 2References
1 Hani R, Ben-Aissi M, Bassir RA, Berrada MS. [Post-traumatic pure dislocation of the elbow: what is the outcome?]. The Pan African medical journal 2018. link
2 O'Brien MJ, Lee Murphy R, Savoie FH. A preliminary report of acute and subacute arthroscopic repair of the radial ulnohumeral ligament after elbow dislocation in the high-demand patient. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2014. link
3 Martin DJ, Fazzi UG, Leach WJ. Brachial artery transection associated with closed and open dislocation of the elbow. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2005. link
4 Mehta JA, Bain GI. Elbow dislocations in adults and children. Clinics in sports medicine 2004. link
5 Minford EJ, Beattie TF. Hanging arm method for reduction of dislocated elbow. The Journal of emergency medicine 1993. link90512-6)
6 Wilson A. Bilateral elbow dislocation. The Australian and New Zealand journal of surgery 1990. link
7 Andersen K, Mortensen AC, Grøn P. Transverse divergent dislocation of the elbow. A report of two cases. Acta orthopaedica Scandinavica 1985. link
8 Exarchou EJ. Lateral dislocation of the elbow. Acta orthopaedica Scandinavica 1977. link