Elbow Fractures and Dislocations

Descriptors

Simple elbow dislocation (no fracture), terrible triad (coronoid fracture, radial head fracture, LUCL tear), radial head fracture, coronoid fracture, olecranon fracture

Exam Pearls

Upper extremity neurovascular exam

Evaluate status of the skin (open injury, skin threatening)

Document flexion/extension, pronation-supination

Test extensor mechanism (non or minimally displaced olecranon fx)

Evaluate varus/valgus instability (post-reduction, if applicable)

Examine wrist and shoulder for associated injuries (fracture, shoulder dislocation, DRUJ injury/Essex-Lopresti)

Consider intra-articular hematoma block if apparent mechanical block to motion (radial head fracture)

Rare: compartment syndrome

Workup

Radiographs: AP and lateral elbow XR; add shoulder, forearm, and wrist if pain on exam. Post-reduction XRs

Other imaging: CT elbow post-reduction to r/o complex dislocation, terrible triad, etc. OR if mechanical block to motion in isolated radial head fx

Labs: None

Other: None

Management

Need for acute intervention:
Dislocation: reduction and immobilization
No associated dislocation: immobilization without reduction

Weight-bearing and range of motion: NWB UE, ROMAT wrist and distal (unless suspicion for DRUJ injury, then immobilize wrist)

Type of immobilization:
- Isolated radial head w/o block: sling for comfort, early ROM
- Simple elbow dislocation: Closed reduction and posterior slab splint x 1wk, early ROM if stable after reduction
- Complex elbow fracture/dislocation: Closed reduction and posterior slab splint following hematoma block or under conscious sedation
- Other fractures: posterior slab splint; add sugartong or lateral/medial strut for terrible triad

Admission or discharge status: Admit: terrible triad, +/- olecranon (patient factor-dependent)
Discharge: simple elbow dislocation, radial head fracture, coronoid fracture, +/- olecranon fracture

Anticoagulation: Standard lovenox/subcutaneous heparin if admitted
None if discharged

Antibiotics: None, unless open

Surgical Indications

Absolute: Open fracture, compartment syndrome, terrible triad, radial head fracture with mechanical block to motion, displaced olecranon fracture

Relative: Radial head fracture with >2mm displacement/angulation

Not an indication: Simple elbow dislocation, minimally displaced coronoid fracture, nondisplaced olecranon fracture