Posterior Elbow Dislocation

The elbow is the second most commonly dislocated major joint in adults and the most common in children, 80% of elbow dislocations occur posterolateral. Here’s a quick summary.

• Second most common major joint dislocation overall (most common in children) with 80% occurring posterolateral, peak age 10-20 

• Named based on anatomic location of olecranon relative to humerus; simple = no fracture, complex = fracture 

• Mechanism: fall onto outstretched hand 

• Exam: swelling with obvious deformity, elbow is flexed with prominent olecranon 

• Possible associated injuries: Fractures (medial/lateral epicondyle > radial head > coronoid process), neuropraxia (anterior interosseous nerve [can't make A-OK sign] most common), ligamentous injury (LCL > MCL), brachial artery injury 

• Terrible triad = posterior dislocation + radial head fracture + coronoid process fracture 

• ED Management: Simple, pain control +/- procedural sedation and reduction; Complex, involve orthopedics 

• Splint: Posterior long arm 

• Ortho consult: No, if simple; Yes, if complex 

• Disposition: Simple, DC with ortho follow-up within 1 week;  Complex, pending orthopedic recommendations 



MH/CCF/CWRU EM Res @MetroHealth_EM



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