Elbow Dislocation
Simple & Complex Elbow Dislocations
Expert care for elbow instability - from acute dislocation to chronic instability
Understanding Elbow Dislocation
The elbow is the most commonly dislocated large joint in children and the second most common in adults. The majority (90%) are posterolateral dislocations, where the forearm bones displace posteriorly and laterally relative to the humerus.
Epidemiology
- • Incidence: 6-13 per 100,000 person-years
- • Most common in ages 10-20 years
- • Males affected more than females
- • Sports-related injuries common in young adults
- • Falls common mechanism in elderly
Types of Elbow Dislocation
Definition: No associated fractures
Soft tissue injury: Lateral collateral ligament (LCL) always torn, medial collateral ligament (MCL) may be intact or torn
Stability: Usually stable after reduction
Treatment: Closed reduction + early motion
Prognosis: Generally excellent
Definition: Associated with fractures
Common fractures: Radial head, coronoid process, medial/lateral epicondyle
Stability: Often unstable after reduction
Treatment: Usually surgical
Prognosis: Depends on injury pattern and treatment
Terrible Triad
Elbow dislocation + radial head fracture + coronoid fracture. This injury pattern is inherently unstable and requires surgical treatment of all components to restore stability.
Presentation & Assessment
Clinical Presentation
Essential Assessment
Neurovascular Exam
Check radial/ulnar pulses, median/radial/ulnar nerve function before and after reduction
X-rays
AP and lateral views confirm dislocation direction and identify associated fractures
CT Scan
Post-reduction CT for complex injuries to assess fracture patterns
Treatment
First step for all elbow dislocations (unless open injury):
Technique
- Adequate analgesia/sedation or anesthesia
- Correction of any medial/lateral displacement
- Gentle traction on forearm with elbow slightly flexed
- Forward pressure on olecranon while maintaining traction
- Elbow should reduce with palpable "clunk"
Post-Reduction
- • Check neurovascular status
- • Confirm reduction with X-rays
- • Assess stability through ROM arc
- • Determine stable arc of motion
If stable through functional arc after reduction:
- • Posterior splint at 90° for comfort (3-7 days)
- • Early motion is critical - start within 1-2 weeks
- • Avoid varus stress if LCL injured
- • Progress ROM over 4-6 weeks
- • Strengthening after 6 weeks
- • Return to sports: 3-6 months (sport dependent)
Indications for surgery:
- • Complex dislocations with fractures
- • Instability after closed reduction
- • Recurrent instability
- • Open dislocation
- • Neurovascular injury requiring exploration
Surgical Options
- • Fracture fixation (radial head, coronoid, etc.)
- • Radial head replacement if unrepairable
- • LCL repair (primary or reconstruction)
- • MCL repair if grossly unstable
- • External fixator for persistent instability
Recurrent Instability
Chronic elbow instability can develop after acute dislocation, particularly in young athletes. Posterolateral rotatory instability (PLRI) is the most common pattern, caused by insufficiency of the lateral collateral ligament complex.
• Clicking or clunking with extension
• Feeling of instability
• Pain with pushing up from chair
• Apprehension with forearm supination
• LCL reconstruction (typically palmaris longus graft)
• Isometric graft placement critical
• Post-op: hinged brace × 6 weeks
• Return to sport: 4-6 months
Evidence & References
• O'Driscoll SW, et al. The unstable elbow. JBJS Am 2000
• Josefsson PO, et al. Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint. JBJS Am 1987
• Ring D, Jupiter JB. Fracture-dislocation of the elbow. J Bone Joint Surg Am 1998
• Anakwe RE, et al. Patient-reported outcomes after simple dislocation of the elbow. JBJS Am 2011
Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)