Shoulder Elbow iSAWE 18

Radiograph and mechanism

• Posterolateral dislocation of the elbow without fracture (simple dislocation)
• Axial load, valgus, supination and external rotation
• Horii circle, injury progresses from the LCL complex anteriorly and posteriorly to the MCL
• LUCL injury is the primary lesion

Reduction and assessment

• Document median, ulnar and radial nerve function and pulses
• Sedation, correct medial or lateral shift, then traction with forearm supinated and elbow flexed
• Check range after reduction, note the extension at which it redislocates
• Post reduction films to confirm a concentric joint and exclude fractures
• CT if fractures of the coronoid or radial head are suspected

Rehabilitation

• Short period of splinting for comfort, under one week
• Early active motion within the stable arc, overhead motion protocol
• Pronation protects LCL deficient elbows
• Prolonged immobilisation over 3 weeks causes stiffness

Surgery

• Elbow unstable within 30 degrees of extension despite pronation
• Incarcerated fragments or non concentric reduction
• LCL repair to the lateral epicondyle, then MCL repair if still unstable
• Hinged external fixator for persistent instability

Related pages

• Acute Elbow Dislocation
• Complex Elbow Instability