From the Guidelines
Management of a dislocated elbow requires prompt reduction followed by appropriate rehabilitation, with the goal of minimizing morbidity, mortality, and improving quality of life. The initial treatment involves pain control with analgesics such as ibuprofen (400-600mg every 6 hours) or acetaminophen (1000mg every 6 hours), combined with stronger medications like oxycodone (5-10mg every 4-6 hours) if needed for severe pain 1. Reduction should be performed as soon as possible, typically under procedural sedation using medications like midazolam (1-2mg IV) and fentanyl (50-100mcg IV) or propofol (0.5-1mg/kg IV). After successful reduction, the elbow should be immobilized in a posterior splint at 90 degrees of flexion for 5-7 days. Following immobilization, early controlled motion should begin to prevent stiffness, starting with gentle active range of motion exercises. A hinged elbow brace may be used to protect the joint while allowing controlled movement.
Some key points to consider in the management of a dislocated elbow include:
- The importance of prompt reduction to minimize the risk of complications such as avascular necrosis, heterotopic ossification, and persistent instability 2
- The use of diagnostic imaging, such as CT or MRI, to evaluate the extent of the injury and guide treatment decisions 3
- The need for physical therapy to restore range of motion, strength, and function, which typically continues for 6-12 weeks 4
- The potential for residual stiffness or mild instability, even with appropriate management 1
Overall, the management of a dislocated elbow requires a comprehensive approach that prioritizes prompt reduction, appropriate rehabilitation, and careful monitoring to minimize morbidity, mortality, and improve quality of life.
From the Research
Management for Dislocated Elbow
The management for a dislocated elbow can be divided into several approaches, including reduction techniques, conservative treatment, and surgical intervention.
- Reduction techniques for elbow dislocations include traction-countertraction, patient-assisted countertraction, the leverage approach, and the modified Stimson technique 5.
- Conservative treatment involves immobilization in a cast or early functional treatment, with early mobilization showing improved range of motion and clinical outcome scores compared to immobilization 6, 7.
- Surgical intervention may be necessary for unstable elbows, with operative management involving exploration, lateral ligament repair or reconstruction, and assessment of the need for medial ligament repair or reconstruction 8.
- The choice of treatment depends on the severity of the dislocation, the presence of any complications, and the patient's overall health and activity level.
Treatment Outcomes
Studies have shown that early functional treatment is the evidence-based therapeutic standard for simple elbow dislocation, with improved outcomes in terms of range of motion, pain, and return to work 6, 7.
- A systematic review found that early mobilization after conservative treatment strategies showed improved range of motion compared to immobilization, with less extension deficit in the early mobilization group 7.
- Another study found that surgical approaches showed similar results compared to conservative treatment, leading to improved range of motion and clinical outcome scores 7.
Complications and Considerations
Complications of elbow dislocations can include nerve injury, vascular injury, and compartment syndrome 5.