Elbow dislocations
Elbow dislocations are a common emergency department presentation: the second most frequent major‑joint dislocation in adults and the most common in children.
Most (≈80-90%) are posterolateral rotatory dislocations produced by axial loading on an outstretched hand with external rotation and a valgus force; the lateral collateral complex usually fails first, then the medial structures (GOV.UK synopsis).
ED management focuses on documented, repeated neurovascular assessment, appropriate imaging, safe analgesia/sedation, timely reduction when indicated, followed by immobilisation, radiographic confirmation and arranged orthopaedic follow‑up (NICE NG38; RCEM).
Clinical assessment
- Primary survey
- Manage life‑threatening injuries first in polytrauma.
- When isolated, control severe pain and immobilise the limb.
- History
- Mechanism of injury (e.g., FOOSH, direct blow).
- Time since injury.
- Prior elbow problems or previous dislocations.
- Symptoms suggesting ischaemia or nerve injury.
- Inspection
- Obvious deformity and swelling.
- Skin integrity; open dislocation requires immediate orthopaedic and vascular input.
- Bruising and neurocutaneous signs.
- Neurovascular examination
- Document and record findings before any manipulation and repeat immediately after reduction.
- Motor and sensory testing: