Elbow Dislocations and Fractures

bones of the elbow joint are forced out of normal alingment

elbow dislocation

break in one or more of the bones that make up the elbow joint

elbow fracture

where can an elbow fracture occur?

• radial head

• olecranon

• distal humerus

• monteggia (ulna fx and dislocation of radius)

• joint displacement without accompanying fc

• 2nd most common dislocation of UE

• seen in young adults doing sports

simple elbow dislocation

joint displacement with accompanying fx

complex elbow dislocation

what causes elbow dislocations?

• FOOSH

• trauma from sports injury or vehicle accidents

• congenital laxity or instability

what causes elbow fx?

• direct trauma (fall, blow)

• high impact injuries

• osteoporosis

incidence

• 34/5-75% occur during sports

• highest incidence 10-19 y/o

• more common in males

• most common large joint to dislocate in kids

• 20-26% involve associated fx

• most common cause: FOOSH

elbow dislocation signs and symptoms

• severe pain & swelling

• visible deformity

• loss of movement

• bruising and tenderness

• numbness or tingling (nerve involvement)

• circulatory issues

elbow fracture signs symptoms

• increase pain with movement

• swelling and bruising

• tender to touch

• possible deformity

• limited ROM

• popping or crackling sensation (crepitus)

what population generally have lower rates of contracture and loss of motion?

children

how many degrees of terminal extension may patients lose?

10-15

how long may it take to regain extension?

5 months

• standard initial treatment for most elbow dislocations

• performed manually to reposition the bones without surgical intervention

closed reduction

• indicated in complex dislocations or cases where closed reduction is unsuccessful due to fractures or other complications

open reduction

immobilization methods

• splints

• slings

• casts

• commonly used to stabilize the elbow after reduction, allowing for proper healing

• elbow is immobilized at about 90 degrees flexion in a posterior splint

splints

• provide support and reduce movement, especially useful for non-surgical cases

slings

may be used in instances where prolonged immobilization is necessary, particularly after surgical interventions

casts

• generally indicated for displaced fx or complex elbow injuries

• restores bone structure and stability using plates or screws

ORIF (open reduction internal fixation)

• essential for addressing severe elbow instability, especially when associated with dislocations

• surgical techniques may involve repairing or reconstructing the injured ligaments using grafts

ligament repair

pain and inflammation management

• NSAIDs

• Ice: first 72 hours; 15-20 min at a time

• rest: balanced with gentle movement to prevent stiffness

• encouraged to promote recovery and maintain ROM

• can lead to better functional outcomes compared to prolonged immobilization

early mobilization

• traditional approach may lead to stiffness and reduced ROM

• avoid immobilization longer than 3 weeks to enhance recovery

prolonged mobilization

what is the general progression of tx?

• immobilization

• ROM

• strengthening

what kind of orthoses may be used?

• static progression

  • enhance recovery outcomes by effectively improving ROM after trauma

what PAMS are used?

• heat therapy

• cold therapy

• NMES

• ultrasound

when is heat therapy used?

• functional rehab stage

• releases stiffness, increases blood flow, reduces pain

• applied before exercise to improve tissue extensibility

when is cold therapy used?

• reduce swelling and pain

• used after exercise to minimize inflammation and pain

neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation (TENS)

• improves joint pain and swelling

• prevents muscle atrophy

• increase ROM

• muscle strengthening

when is ultrasound used

• reduce inflammation and promote healing

what exercises can be used?

• elbow flex/ext

• wrist rotation

• PROM

general principles of activity modification

• individualization

• gradual progression

• pain monitoring

• education

• collaboration