Assessment and decision making in the unstable elbow: management of simple dislocations

Abstract

Simple elbow dislocations are usually treated conservatively. Radiographs are negative in simple dislocations. Results are generally good, although a small percentage of patients may develop chronic instability. Ligamentous repair can be indicated in high demand patients or if the elbow remains unstable following a closed reduction. Chronic instability is classified per their direction. Surgery is often indicated in the chronically unstable elbow.

Keywords: elbow; instability; ligament.

Figure 1.

Anteroposterior radiograph of an elbow after a complex elbow dislocation. The elbow has been reduced and is congruent but there is a medial condylar fracture (courtesy of MoRe Foundation).

Figure 2.

Anteroposterior radiograph of a simple elbow dislocation (courtesy of MoRe Foundation).

Figure 3.

Three-dimensional reconstruction computed tomography image showing a small coronoid fracture (courtesy of MoRe Foundation).

Figure 4.

Magnetic resonance imaging of an elbow still in plaster following a closed reduction of a dislocated elbow. This image shows a complete rupture of the medial collateral ligament and lateral collateral ligament complexes and clear bony edema in the posterior part of the capitellum (courtesy of MoRe Foundation).

Figure 5.

Dynamic brace to protect the elbow when motion is permitted (courtesy of MoRe Foundation).

Figure 6.

Intraoperative photograph showing reinsertion of the avulsed lateral collateral ligament and extensor tendon complex. A bone anchor was used and sutures were placed lateral collateral ligament and extensor tendon mass (courtesy of MoRe Foundation).

Figure 7.

Intraoperative photograph of a complete medial collateral ligament tear. A longitudinal rent in the anteromedial capsule is also visible (courtesy of MoRe Foundation).

Figure 8.

Varus stress test. This test needs to be repeated in multiple angles of flexion as different structures will be responsible for stability at different angles (courtesy of MoRe Foundation).

Figure 9.

Valgus stress test of the elbow (courtesy of MoRe Foundation).

Figure 10.

The pivot shift test is performed by applying compression and valgus stress to the supinated forearm, when it is moved from flexion to extension (courtesy of MoRe Foundation).

Figure 11.

The chair test to test posterolateral rotatory instability. The test is positive if the patient is unable to fully extend the elbow when loading, whereas unloaded extension is no problem (courtesy of MoRe Foundation).