Working Diagnosis:
Lateral elbow dislocation

Treatment:
The patient's elbow was reduced using supination and direct traction in the ED with Xray confirmation of reduction. Case Photo #9 Case Photo #10 Sensation returned to fifth finger, and pain improved. She was placed in a posterior splint until she started with OT one week later.

Outcome:
At 4 weeks post-injury, pain was reduced and strength improved. Range of motion improved to 5 to 135 degrees with both pronation and supination of 90 degrees. She had a full recovery after 12 weeks and has already resumed bouldering.

Author's Comments:
Bouldering is indoor rock-climbing on lower walls without ropes or a safety harness. The only safety measures in place are thick padded landing mats and spotters. Climbers must develop techniques to fall safely. Our case shows that even an experienced climber can sustain a significant injury after a fall while bouldering. Future studies should focus on reducing injuries while climbing, with a focus on bouldering techniques and novel prevention strategies.

Editor's Comments:
The elbow is the second most commonly dislocated joint. 74% of elbow dislocations are considered simple, without bony pathology. Falls that lead to an externally rotated, valgus, axially directed load usually lead to simple dislocations. 90% of elbow dislocations are posterior or posterolateral displacement of the ulna relative to the distal humerus. With any joint dislocation neurovascular assessment before and after reduction is important. Ligament stability should be assessed either on exam or with advanced imaging. Posterior splinting after reduction should occur for no longer than 1 week.

References:
Rezaie N, Gupta S, Service BC, Osbahr DC. Elbow Dislocation. Clin Sports Med. 2020 Jul;39(3):637-655. doi: 10.1016/j.csm.2020.02.009. PMID: 32446580.
Robinson PM, Griffiths E, Watts AC. Simple elbow dislocation. Shoulder Elbow. 2017 Jul;9(3):195-204. doi: 10.1177/1758573217694163. Epub 2017 Jan 1. PMID: 28588660; PMCID: PMC5444606.
Frank, R. Cohen M. Elbow Dislocation
https://www.orthobullets.com/trauma/1018/elbow-dislocation. Accessed 2/11/2021

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