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ELBOW DISLOCATION
Dislocations of the elbow occur with a fall on the outstretched
arm. They may be in the posterior or posterior lateral direction
(Figure 18.24).
In children, the medial epicondyle of the humerus is often
pulled off as the radius and ulna move posteriorly and laterally.
With reduction, this fragment may become lodged in the joint
and require surgical removal.
Evaluation
Clinically examine the triangular relationship of the ulna
and the two epicondyles to ascertain if it is disturbed. The
olecranon is felt protruding in a posterior direction and any
elbow motion is painful. Assess and record ulnar nerve function.
Treatment
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Treat
with immediate closed reduction: apply traction to
the arm with the elbow in slight flexion and direct
pressure on the tip of the olecranon to push it distally
and anteriorly. |
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When
reduced, the elbow will have a free range of motion.
After reduction, confirm the position of the epicondyle
by X-ray. |
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Place
the arm in a posterior splint at 90 degrees of flexion. |
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Begin
a range of motion at the elbow after 10 days, or
as soon as the pain and swelling permit, removing
the splint for short periods. Discontinue the splint
at 4–6 weeks. |
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