From the Guidelines
The proper technique for elbow fracture reduction is to not move or try to straighten an injured extremity unless absolutely necessary, and instead, stabilize the extremity with a splint in the position found to prevent further injury and reduce pain 1.
Key Considerations
- When reducing an elbow fracture, it is crucial to avoid causing further injury to the surrounding soft tissues, including muscles, tendons, and ligaments.
- Diagnostic imaging plays a key role in assessing acute elbow pain and identifying the damaged structures, which can help guide treatment and surgical planning 1.
- Closed reduction may be attempted under fluoroscopy to evaluate joint stability, and stability should be assessed in various positions, including flexion, pronation, supination, and varus and valgus stress 1.
Reduction Techniques
- Schnetzke et al evaluated joint stability in patients with simple elbow dislocation and found that patients with mild instability achieved better outcomes with conservative measures, while those with gross instability required surgical fixation 1.
- In general, splinting may reduce pain and prevent further injury, and a splint should be padded to cushion the injury 1.
Important Reminders
- Do not attempt to reduce a fracture unless you are a trained medical professional, and seek immediate medical attention if the injured extremity is blue or extremely pale 1.
From the Research
Elbow Fracture Reduction Techniques
The proper technique for elbow fracture reduction involves achieving anatomic reduction of any fracture or dislocation, while allowing for early range of motion to minimize future morbidity, including elbow stiffness and limited mobility of the joint 2.
Reduction Methods
Several reduction techniques are available, including:
- Traction-countertraction
- Patient-assisted countertraction
- The leverage approach
- The modified Stimson technique 3
- A novel single-person reduction technique, which has been shown to be a valid option for orthopedic surgeons treating elbow dislocations, requiring less sedation, assistance, and supplies compared to traditional methods 4
Surgical Approaches
For open reduction and internal fixation of capitellum fractures, the limited anterior approach of the elbow is a technical option to consider, as it does not involve the detachment of any muscle group or ligament, facilitating the recovery process 5. However, most elbow fractures are best treated operatively with restoration of normal bony anatomy and rigid internal fixation and repair and/or reconstruction of the collateral ligaments 6.
Key Considerations
When performing elbow fracture reduction, it is essential to recognize and appropriately manage associated soft tissue injuries, as elbow fractures are challenging to treat due to the complex anatomy of the elbow joint 6. Additionally, complications such as nerve injury, vascular injury, and compartment syndrome can occur, emphasizing the need for careful technique and monitoring 3.