Elbow dislocationsMANAGEMENT

ARM & ELBOW · 12 SECTIONS

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547 items

☷ Legend

01Approach to the Critical Patient/attcp71

Immediate priorities

›Initial stabilization

›Airway risk

›Procedural sedation planning

›Aspiration risk factors

›Breathing compromise

›Hypoxia triggers alternative analgesia plan

›Capnography for sedation

›Circulation compromise

›Hemorrhage concern for open injury

›IV access for sedation and analgesia

›Disability concern

›Altered mental status triggers head injury pathway

›Intoxication triggers higher monitoring tier

›Limb threat screen

›Neurovascular status

›Radial pulse

›Ulnar pulse

›Capillary refill

›Hand warmth and color

›Motor function

›Median nerve

›Thumb opposition

›AIN pinch

›Ulnar nerve

›Finger abduction

›Froment sign

›Radial nerve

›Wrist extension

›MCP extension

›PIN finger extension

›Sensory function

›Median nerve

›Index fingertip

›Ulnar nerve

›Small fingertip

›Radial nerve

›Dorsal first web space

›Ischemia triggers

›If pulseless limb, immediate reduction attempt

›If pulseless after reduction, urgent vascular surgery and CT angiography

›If expanding hematoma, immediate specialist activation

›Reduction urgency triggers

›Neurovascular compromise

›If evolving deficit, immediate reduction over delayed imaging

›If persistent deficit post-reduction, urgent orthopedics

›Threatened skin

›Skin tenting

›Blanching

›Open dislocation

›Antibiotics and tetanus pathway first when feasible

›Urgent ortho and possible transfer

›Documentation checkpoints

›Pre-reduction neurovascular exam

›Time-stamped exam

›Deficits explicitly described

›Post-reduction neurovascular exam

›Repeat and compare to baseline

›Persistent deficit escalation

Key concepts

›Core concepts

›Simple dislocation

›No associated fracture requiring fixation

›Ligament injury common

›Complex dislocation

›Associated fracture

›Terrible triad risk pattern

›Posterior and posterolateral patterns

›Most common directions

›Mechanism often FOOSH with valgus and supination

›Stiffness risk

›Prolonged immobilization increases contracture risk

›Early mobilization favored when stable

02History/hx36

Mechanism and trajectory

›Injury context

›FOOSH

›Elbow position at impact

›Valgus load

›Direct blow

›High-energy concern

›Open injury concern

›Sports mechanism

›Fall from height

›Collision

›Time since injury

›Delay to reduction

›Prior reduction attempt

›Symptoms and red flags

›Pain severity trajectory

›Pain out of proportion

›Increasing tightness

›Neurologic symptoms

›Numbness distribution

›Weakness distribution

›Vascular symptoms

›Cold hand

›Color change

›Baseline and modifiers

›Hand dominance

›Occupational demands

›Baseline ROM limitations

›Prior elbow injury

›Instability history

›Prior surgery or hardware

›Anticoagulants and bleeding risk

›DOAC use

›Warfarin use

›Comorbid risk

›Osteoporosis risk factors

›Seizure history

03Physical Exam/exam48

Focused elbow and limb exam

›General assessment

›Deformity pattern

›Posterior prominence of olecranon

›Anterior skin tension

›Swelling severity

›Tense compartments concern

›Bullae or fracture blisters

›Skin integrity

›Abrasions

›Laceration over joint

›Elbow-specific findings

›Range of motion

›Mechanical block

›Pain-limited arc

›Palpation targets

›Radial head tenderness

›Coronoid region tenderness

›Medial epicondyle tenderness

›Stability checks after reduction

›Varus stress

›Valgus stress

›Posterolateral rotatory instability signs

›Neurovascular exam

›Vascular

›Radial pulse palpation

›Doppler signal if weak pulse

›Cap refill

›Nerve exam

›Median nerve motor and sensory

›Ulnar nerve motor and sensory

›Radial nerve motor and sensory

›Compartment syndrome screen

›Forearm compartments

›Pain with passive finger extension

›Increasing analgesic requirement

›Hand compartments

›Intrinsic tightness

›Pain with passive MCP extension

PITFALLS

›Common pitfalls

›Missed associated fracture

›Radial head fracture

›Coronoid fracture

›Missed neurovascular injury

›Ulnar neuropraxia masked by pain

›Brachial artery injury despite palpable pulse

›Over-immobilization

›Stiffness and heterotopic ossification risk

›Functional loss from prolonged splinting

04Differential Diagnosis/ddx39

Traumatic elbow pathology

›Dislocation patterns

›Posterior dislocation

›Simple pattern possibility

›Associated fracture screening

›Posterolateral dislocation

›LCL injury pattern

›Terrible triad association

›Posteromedial dislocation

›Anteromedial coronoid facet injury risk

›Varus posteromedial instability risk

›Anterior dislocation

›High-energy mechanism association

›Neurovascular injury risk

›Divergent dislocation

›High-energy association

›Complex instability risk

›Fractures and fracture-dislocations

›Radial head fracture

›Mason classification relevance

›Mechanical block risk

›Coronoid fracture

›Regan-Morrey classification relevance

›Instability risk marker

›Olecranon fracture-dislocation

›Posterior elbow instability mimic

›Extensor mechanism disruption

›Distal humerus fracture

›Elbow deformity mimic

›Surgical fixation likelihood

›Mimics and nearby injuries

›Elbow hemarthrosis without dislocation

›Occult radial head fracture pathway

›Fat pad sign relevance

›Radial head subluxation

›Pediatrics mechanism

›No deformity typical

›Biceps tendon rupture

›Anterior elbow pain and weakness

›Hook test relevance

05Laboratory Tests/lt24

Labs by scenario

›Routine labs

›No labs for isolated stable simple dislocation

›Imaging-driven diagnosis

›Clinical monitoring focus

›Planned procedural sedation tier

›Glucose if hypoglycemia risk

›Pregnancy test when applicable

›Trauma and operative pathway

›Open dislocation

›CBC for blood loss and baseline

›Electrolytes and creatinine for antibiotic dosing

›Polytrauma

›Type and screen for hemorrhage concern

›Lactate for shock trend

›Anticoagulated patient

›INR if warfarin use

›Renal function if DOAC use

›Compartment or ischemia concern

›CK for muscle injury concern

›Rising trend supports compartment concern

›Normal CK does not exclude early compartment syndrome

›Creatinine and potassium

›Rhabdomyolysis complication screening

›Fluid strategy implications

06Diagnostic Tests/dt67

Scoring Systems

›Classification and implications

›Simple vs complex elbow dislocation classification

›Simple definition

›No fracture requiring fixation

›Early mobilization pathway when stable

›Complex definition

›Associated fracture

›Higher operative consultation urgency

›Direction classification

›Posterior pattern

›Most common

›LCL injury common

›Posterolateral pattern

›Terrible triad association

›PLRI risk

›Posteromedial pattern

›Anteromedial coronoid facet risk

›Varus posteromedial instability

›Associated fracture classifications

›Mason radial head classification

›Type I

›Type II

›Type III

›Regan-Morrey coronoid classification

›Type I

›Type II

›Type III

Radiographs

›X-ray strategy

›Initial imaging

›Elbow AP view

›Elbow lateral view

›Oblique views when fracture suspected

›Key radiographic checks

›Ulnohumeral alignment on lateral

›Radiocapitellar alignment on all views

›Radial head fracture signs

›Post-reduction imaging

›Repeat AP and lateral

›Joint congruity confirmation

›Fracture fragment reassessment

›Pearls

›Fat pad sign relevance

›Small coronoid fragments as instability markers

MRI

›Soft tissue and instability evaluation

›Indications

›Recurrent instability

›Persistent pain with normal X-ray

›Suspected collateral ligament injury affecting stability

›Targets

›LCL complex integrity

›MCL integrity

›Cartilage injury

›Limitations

›Acute swelling and pain limiting tolerance

›Management often guided by stability exam and CT for fractures

›Fracture definition and surgical planning

›Indications

›Complex dislocation suspected

›Intra-articular fracture suspected

›Loose body suspicion

›Targets

›Radial head comminution

›Coronoid fracture morphology

›Distal humerus articular injury

›Vascular imaging

›If pulseless after reduction, CT angiography upper extremity

›If hard signs of vascular injury, immediate specialist involvement over delayed imaging

07Disposition/dispo34

Disposition tiers

›Discharge candidates

›Simple dislocation reduced

›Stable joint on post-reduction exam

›Intact neurovascular exam

›Pain controlled with oral regimen

›Ability to sleep and function

›No escalating swelling trend

›Reliable follow-up

›Orthopedics or fracture clinic timeline

›Return precautions understood

›Admission candidates

›Neurovascular compromise

›Persistent deficit post-reduction

›Vascular compromise concern

›Complex dislocation

›Associated fracture requiring operative planning

›Irreducible dislocation

›Uncontrolled pain

›High opioid requirement

›Concern for compartment syndrome

›Transfer triggers

›Vascular surgery requirement

›Pulseless after reduction

›Hard signs of vascular injury

›Ortho trauma capability requirement

›Terrible triad pattern

›Unstable joint requiring early surgery

›Follow-up timing

›Simple stable dislocation

›Ortho follow-up in 3 to 7 days

›Early ROM plan

›Complex dislocation

›Ortho follow-up within 24 to 72 hours

›Surgical planning pathway

08Treatment/t127

Immediate life-saving interventions

›Threat mitigation

›If pulseless limb, immediate reduction attempt

›Pre-reduction rapid neurovascular check

›Post-reduction pulse reassessment

›If open dislocation, antibiotics and tetanus pathway first when feasible

›Sterile moist dressing

›Ortho activation

›Constriction relief

›Ring removal

›Splint loosening if worsening perfusion

Immobilization and Splinting

›Splint selection and position

›Posterior long arm splint

›Elbow flexion position based on stability

›Forearm rotation based on stability exam

›Sling support

›Shoulder comfort

›Elevation strategy

›Immobilization principles

›Post-reduction neurovascular recheck

›Pulse and cap refill

›Motor and sensory

›Swelling-phase precautions

›Avoid circumferential casting acutely

›Extra padding over olecranon

›Early motion planning

›Stable simple dislocation favors early supervised ROM

›Avoid prolonged immobilization beyond 2 weeks when stable

Reduction

›Indications for reduction

›Neurovascular compromise

›Immediate reduction prioritized

›Persistent deficit escalation

›Threatened skin

›Blanching over anterior elbow

›Skin tenting

›Gross deformity and severe pain

›Functional restoration

›Pain relief

›Contraindications or caution triggers

›Suspected complex fracture-dislocation

›Gentle technique

›Low threshold for ortho involvement

›Suspected vascular injury

›Hard signs trigger specialist activation

›Avoid repeated attempts delaying definitive care

›Analgesia and anesthesia options

›Non-opioid baseline

›Acetaminophen 1000 mg PO

›Ibuprofen 400 mg PO

›Opioid titration

›Fentanyl IV 25 to 50 mcg increments

›Reassess every 3 to 5 minutes

›Regional anesthesia

›Infraclavicular brachial plexus block when expertise available

›Axillary block when expertise available

›Procedural sedation pathway

›Monitoring

›Continuous pulse oximetry

›Continuous ECG

›Noninvasive BP every 3 to 5 minutes

›Capnography

›Sedation options

›Ketamine IV 1.0 mg/kg

›Repeat 0.5 mg/kg every 5 to 10 minutes as needed

›Hypersalivation management plan

›Propofol IV 0.5 mg/kg

›Repeat 0.25 to 0.5 mg/kg every 2 to 3 minutes as needed

›Hypotension risk plan

›Ketofol option

›Ketamine 0.5 mg/kg IV

›Propofol 0.5 mg/kg IV

›Reduction technique principles

›Traction and countertraction

›Distal forearm traction

›Proximal arm countertraction

›Gentle sustained force

›Avoid repeated forceful attempts

›Muscle relaxation emphasis

›Posterior dislocation maneuvers

›Longitudinal traction with gradual elbow flexion

›Olecranon guidance into trochlear groove

›Post-reduction requirements

›Immediate neurovascular re-check

›Post-reduction radiographs

›Stability assessment through gentle arc

›Splint in position of stability

›Failed reduction pathway

›Persistent deformity

›Urgent orthopedics

›Consider interposed fracture fragment

›Persistent pulselessness

›Immediate vascular surgery

›CT angiography if available without delaying surgery

›Worsening pain and tight compartments

›Compartment syndrome escalation

›Fasciotomy consultation pathway

Open fracture medications and timing

›Antibiotic pathway

›First-line for open joint or open fracture concern

›Cefazolin IV 2 g

›Repeat dosing per local protocol and weight

›Severe beta-lactam allergy

›Clindamycin IV 900 mg

›Add gram-negative coverage for high contamination per local protocol

›Contamination modifiers

›Farm or soil contamination triggers broader coverage

›Water exposure triggers organism-specific coverage

›Tetanus prophylaxis

›Unknown or incomplete immunization

›Tdap

›Tetanus immune globulin for high-risk wounds

›Up-to-date immunization

›Booster per wound classification

›Wound care

›Sterile saline irrigation

›Moist sterile dressing

›Avoid aggressive probing in ED

DVT prophylaxis when relevant

›Risk assessment

›Upper extremity immobilization usually low risk

›High-risk features

›Prior VTE

›Active cancer

›Prolonged immobility

›Contraindications

›Active bleeding concern

›Planned urgent surgery

›Plan documentation

›Rationale for prophylaxis decision

›Follow-up reassessment plan

09Special Populations/sp33

Pregnancy

›Pregnancy considerations

›Imaging considerations

›X-ray acceptable with shielding when feasible

›CT only when clinically necessary

›Analgesia considerations

›Acetaminophen preferred baseline

›NSAID avoidance in later pregnancy

›Sedation considerations

›Airway risk higher

›Left lateral tilt positioning when feasible

Geriatric

›Geriatric considerations

›Fragility mechanisms

›Ground-level fall pattern

›Osteoporosis context

›Medication sensitivity

›Lower sedation dosing thresholds

›Delirium risk with benzodiazepines and opioids

›Disposition threshold

›Lower tolerance for pain and functional loss

›Higher admission consideration for unsafe home setup

Pediatrics

›Pediatric considerations

›Injury patterns

›Posterior dislocation less common than adults

›Medial epicondyle avulsion association

›Growth plate concerns

›Physeal injury mimic

›Gentle reduction technique

›Dosing

›Weight-based analgesia and sedation

›Ketamine IV 1.0 mg/kg

›Nonaccidental trauma context

›Inconsistent history triggers safeguarding pathway

›Additional injury screening as indicated

10Background/b32

Epidemiology

›Epidemiology overview

›Common large joint dislocation

›Often sports and falls

›Younger adults higher incidence

›Direction frequency

›Posterior patterns most common

›Anterior patterns uncommon and higher-energy

Pathophysiology

›Injury mechanics

›FOOSH with valgus and supination

›LCL disruption sequence

›Posterolateral rotatory instability mechanism

›Complex instability patterns

›Radial head fracture as valgus stabilizer loss

›Coronoid fracture as anterior buttress loss

›Neurovascular injury mechanisms

›Brachial artery stretch or entrapment

›Ulnar nerve traction at medial elbow

Therapeutic Considerations

›Management rationale

›Early reduction

›Restores perfusion

›Reduces skin compromise

›Improves pain control

›Early mobilization when stable

›Reduces stiffness risk

›Improves functional outcome

›Immobilization balance

›Short immobilization for comfort

›Prolonged immobilization increases contracture risk

›Surgical indications

›Gross instability after reduction

›Terrible triad pattern with instability

›Large displaced fractures

11Patient Discharge Instructions/pdi23

copy discharge instructions

›Discharge instructions

›Splint and sling care

›Keep splint clean and dry

›Do not remove splint unless instructed

›Swelling control

›Elevation above heart as much as possible for 48 to 72 hours

›Ice 15 to 20 minutes at a time with skin protection

›Pain plan

›Acetaminophen 1000 mg PO every 6 to 8 hours as needed

›Ibuprofen 400 mg PO every 6 to 8 hours as needed if safe

›Activity restrictions

›No lifting with injured arm

›Keep elbow immobilized until follow-up unless told to start ROM

›Return to ED immediately

›Increasing pain not controlled with medication

›New numbness or weakness in hand or fingers

›Fingers cold, pale, blue, or worsening swelling

›Splint too tight or increasing pressure pain

›Fever

›Wound drainage or redness for open injury

›Follow-up

›Orthopedics or fracture clinic in 3 to 7 days for simple stable dislocation

›Earlier follow-up for associated fracture or instability

12References/r13

Clinical guidelines and evidence sources

›Evidence sources

›ACEP Clinical Policy on procedural sedation and analgesia in the emergency department

›Monitoring standards including capnography guidance

›Discharge readiness criteria after sedation

›Orthopedic society guidance on elbow dislocation management

›Simple dislocation early mobilization emphasis when stable

›Complex dislocation operative consultation thresholds

›ATLS principles for initial trauma assessment

›Neurovascular exam documentation before and after splinting

›Limb-threatening ischemia escalation triggers

›Key classification frameworks

›Mason classification for radial head fractures

›Regan-Morrey classification for coronoid fractures

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed March 6, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.