Image of the Day 31: Right Posterior Elbow Dislocation

This unfortunate 56 years old lady presented to casualty after alleged fall to the ground from a low speed moving 4X4 car. Exact mechanism of injury is unknown.

On examination, patient is conscious and alert with full GCS. Vitals sign are stable and pain score is 5/10. Right elbow is deformed, held on extended position and with small laceration wound at the antecubital fossa. Bone otherwise not exposed. Upon palpation, it is tender, warm and in fix extension position. Examination of the peripheral pulses and nerves function are normal.

Radiological image of the right elbow shows posterior dislocation of the elbow joint. No associated fracture seen on the x ray.

Close manual reduction of the dislocated elbow joint then performed under procedural sedation and analgesia using 5 mg of IV midazolam and 75 microgram of IV Fentanyl. Back slab POP is then applied with elbow in 90 degrees of flexion position. No vascular or nerve injury involvement after the procedure.

Patient is discharged with analgesia, antibiotic and follows up as outpatient in orthopedic clinic.

Discussion

Elbow dislocation is the second most common major joint dislocation in adult after the shoulder joint and 90% of it is attributed to Posterior dislocation.

It normally results from a fall onto an extended abducted arm and usually not associated with neurovascular injury.

Usually the elbow would be in flexion position with exaggerated olecranon prominence

Dislocated elbow joint with association of fracture ideally treated with open reduction and internal fixation while those without the fracture can be reduce manually with sedation and analgesia. Post reduction film must be taken and evaluate for any bone fracture after the close reduction.