Complex Elbow Dislocations

Abstract

Sports practice has become common in all ages, and the number of persons practicing extreme sports has been rapidly increasing. High-risk activities have raised the number and severity of (elbow) lesions that can cause severe disability.

Diagnosis of acute elbow dislocation is usually clinically evident, and reduction should be performed expeditiously. On-field reduction should be performed if an experienced health technician is present. Most of the times, the radiographic evaluation is performed first and usually allows identifying an associated fracture that defines a complex dislocation. Postreduction radiographic control is essential, and frequently CT scan or MRI can complete the information needed to fully understand the lesion and plan the treatment.

Fractures associated with elbow dislocation are frequent, but fortunately most of them are impacted fractures that do not require surgical treatment. When the dislocation causes a fracture of the olecranon, the radial head, and/or the coronoid, this can justify surgical treatment to provide stability and allow for early rehabilitation in an attempt to avoid either the stiffness or the instability.

The most frequent patterns of complex dislocation needing surgical treatment are transolecranon fracture-dislocations and elbow dislocations associated with fracture of the coronoid and/or the radial head. When both coronoid and radial head fractures are present, this pattern of injury is known as “elbow terrible triad” due to the bad outcomes associated with treatment.

Surgical treatment can include open reduction and internal fixation of the fractures, exploration, and repair of the medial collateral ligament and/or the lateral ulnar collateral ligament. Dynamic external fixation is another useful option when the elbow remains unstable even after surgical treatment, allowing an early mobilization while maintaining a concentric and stable reduction. Its use needs a strict technique to avoid possible complications such as radial nerve palsy.

In summary, ensuring a stable elbow that allows an early active range of motion is the critical point to improve elbow function after a complex elbow dislocation.