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Dislocation Reduction of the Elbow Joint

  • Editor(s): Todd W Thomsen, MD, Gary S Setnik, MD, FACEP
  • Section Editor(s): Phillip M Harter, MD
  • Contributor(s): Carmie Chan, MD
PRE-PROCEDURE
INDICATIONS

All elbow dislocations must be reduced.
CONTRAINDICATIONS

There are no absolute contraindications to reduction of a dislocated elbow.


Clinical Pearls: If the dislocation is associated with an open wound or fracture, the patient should be taken to the operating room for irrigation, debridement, and reduction to lessen to chance of joint infection.
ANATOMY
  • With the elbow in extension, the medial and lateral epicondyles of the distal humerus and the olecranon (proximal ulna) lie in line when the posterior elbow is palpated.
  • When the elbow is flexed to 90 degrees, the radial head can be found on the lateral side of the elbow by rotating the forearm.
  • Internal and functional anatomy
    • The biceps tendon inserts on the proximal radius, at the radial tuberosity.
    • The brachialis tendon inserts distal to the coronoid process.
    • The triceps tendon inserts on the olecranon.
    • The ulnar (medial) collateral complex originates on the medial epicondyle, and the anterior band originates on the medial side of the coronoid.
    • The lateral collateral complex originates on the lateral epicondyle and inserts on the proximal radius.
  • Radiographic anatomy
    • In the nondislocated elbow, the radial head will be aligned with the capitellum in all views, irrespective of the position of the elbow. The fat pad sign can indicate trauma.
Posterior elbow dislocation.
Figure 2 :  Posterior elbow dislocation.

Bony anatomy of the elbow, posterior view.
Figure 4 :  Bony anatomy of the elbow, posterior view.


PROCEDURE
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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures
Traction method. 1: Counter-traction. 2: In-line traction. 3: Correction of medial or lateral displacement. 4: Flexion of the elbow.
Figure 9 :  Traction method. 1: Counter-traction. 2: In-line traction. 3: Correction of medial or lateral displacement. 4: Flexion of the elbow.

Mayo technique: 1: Valgus force. 2: Supination. 3: Axial pressure.
Figure 10 :  Mayo technique: 1: Valgus force. 2: Supination. 3: Axial pressure.

Parvin method. 1: Axial traction. 2: Countertraction.
Figure 11 :  Parvin method. 1: Axial traction. 2: Countertraction.

Meyn-Quigley method. 1. Axial traction. 2: Manipulation of the olecranon.
Figure 12 :  Meyn-Quigley method. 1. Axial traction. 2: Manipulation of the olecranon.

Anterior dislocation reduction. 1: Counter-traction. 2: Axial traction. 3: Posteriorly directed pressure.
Figure 13 :  Anterior dislocation reduction. 1: Counter-traction. 2: Axial traction. 3: Posteriorly directed pressure.


POST-PROCEDURE
CARE
  • Apply a splint.
  • Reexamine the neurovascular status of the hand.
  • Repeat radiographs of elbow to confirm reduction.
    • The radial head should be aligned with the capitellum in all views.
  • Prescribe analgesic medications.
  • Arrange for orthopedic follow-up in 1 week.
COMPLICATIONS
  • Neurovascular injury
    • Stiffness in the elbow joint. The loss of 15 to 30 degrees of terminal extension after a dislocation is expected.
  • Heterotopic ossification
  • Distal radioulnar joint instability
  • Lateral elbow instability
Apply a splint.
Figure 14 :  Apply a splint.

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