Working Diagnosis:
Simple posterolateral dislocation of right elbow without fracture.

Treatment:
Closed reduction of elbow dislocation was done by the orthopedic team. Post-reduction imaging was without evidence of fracture. Case Photo #3 , Case Photo #4
A right upper extremity splint was applied. The pateint was instructed to remain in sling at all times and was restricted to no activity for 6 weeks.

Outcome:
At the 2 week follow up visit, x-rays were normal, and the patient was feeling well with exam notable for limited range of motion secondary to splinting. His splint was discontinued, but he was instructed to continue wearing a sling for another week with gradual range of motion progression of elbow and physical therapy. He was cleared for lower extremity training.
At the 6 week visit, patient was doing well and eager to return to sports. Exam showed mild laxity to varus and valgus stress compared to the left but was otherwise normal with full range of motion. He was cleared for progressive return to sports while completing physical therapy.

Author's Comments:
Elbow dislocations are uncommon. Usual mechanisms of injury include falling on an outstretched hand (FOOSH) or trauma. Posterolateral dislocation is most common. People with greater ligamentous laxity or a shallow ulnar groove have a higher risk of dislocation. A simple dislocation does not have any bony injury while a complex dislocation occurs withg bony or ligamentous injury. In severe dislocations, nerve and vessel injury is possible. Patients may also have a 'terrible triad' injury of the elbow, which is characterized by elbow dislocation, radial head/neck fracture, and a coronoid fracture. Reduction of simple dislocations can be done non-surgically with local anesthesia. In this case, the reduction was accomplished with patient prone and a combination of gentle traction and distal ulnar translation. Complex injuries may require surgical intervention to restore bone alignment and/or repair ligaments.

Editor's Comments:
Elbow dislocations are the second most frequent joint dislocation, with shoulder dislocations the most common. Research has shown that early functional range of motion is statistically superior to immobilized for management of elbow dislocations with no increase in re-dislocation rates. Brief immobilization after injury might decrease pain associated with range of motion, but early movement should be started as soon as possible.

References:
Elbow Dislocation Management in the ED: Practice Essentials, Pathophysiology, Epidemiology. E-medicine. (n.d.) Retrieved July 10, 2022.
Elbow Dislocation-Trauma-Orthobullets. (n.d). Retrieved July 10, 2022
Layson J, Best BJ. Elbow Dislocation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
Robinson, P. M., Griffith, E., Watts, A. C. (2017). Simple elbow dislocation. Shoulder and Elbow, 9(3), 195-204.
Schubert, I., Strohm, P. C., Maier, D., & Zwingmann, J. (2021). Simple traumatic elbow dislocations; benefit from early functional rehabilitation: A systematic review with meta-analysis including PRISMA criteria. Medicine, 100(44), e27168.

Return To The Case Studies List.