Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

 

Basic Facts

• Commonly seen in children aged 10–15 years
• Rare below 3 years
• Most common type: posterolateral dislocation
• Relationship between radius and ulna is maintained
  • This helps distinguish it from Monteggia fracture-dislocation

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Treatment of Elbow Dislocation

• Closed reduction
• Early mobilization

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Always Assess For

• Medial epicondyle fracture
• Intra-articular entrapment of fracture fragment

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Indications for Surgery (ORIF)

• Fragment entrapped within the joint
• Significant displacement

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Conditions Associated With or Confused With Elbow Dislocation

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1. Medial Epicondyle Fracture

• Commonly associated with elbow dislocation
• Fragment may be trapped within the joint, leading to incongruity
• Can be difficult to identify, especially after spontaneous reduction

Management

• ORIF when:
  • Fragment is entrapped
  • Significant displacement is present

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2. Nursemaid’s elbow

• Age group: 2–3 years
• Cause: traction injury

Pathology

• Annular ligament slips, resulting in subluxation of the radial head

Clinical Features

• Child refuses to use the arm
• Arm held in slight flexion and pronation
• X-ray appears normal

Treatment

• Reduction using supination and flexion
• Immobilization is not required

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3. Congenital Radial Head Dislocation

• Usually bilateral
• No history of trauma

Findings

• Posterior dislocation
• Hypoplastic capitellum
• Radius appears bowed and shortened

Key Point

• Not reducible

Treatment

• Radial head excision in adulthood if symptomatic

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4. Monteggia Fracture-Dislocation

• Ulna fracture associated with radial head dislocation

Key Diagnostic Feature

• Radiocapitellar line is disrupted

Clinical Points

• Frequently missed injury
• Most common type involves anterior radial head dislocation

Complication

• Posterior interosseous nerve injury

Treatment

• Anatomical reduction of the ulna

If Missed

• Ulnar osteotomy with open reduction

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5. Transphyseal Separation of Distal Humerus

• Seen in very young children, typically below 2–3 years
• Often mistaken for elbow dislocation

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Key Differences

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Important Consideration

• Always evaluate for possibility of non-accidental trauma

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Key Radiological Rule

• Radiocapitellar line:
  • Should pass through the capitellum in all views

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Clinical Use

• Helps differentiate:
  • Elbow dislocation
  • Monteggia lesion
  • Transphyseal injury

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Exam Pearls

• Elbow dislocation is rare below 3 years, consider transphyseal separation
• Entrapped medial epicondyle requires surgical treatment
• Normal X-ray with refusal to use arm suggests nursemaid’s elbow
• Always assess radiocapitellar alignment
• Missed Monteggia lesions can lead to major complications