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Elbow dislocation
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Elbow dislocation | Radiology Reference Article | Radiopaedia.org

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Dr Craig Hacking and Dr Jeremy Jones et al.

Elbow dislocation is the second most common large joint dislocation in the adult population.
A dislocation with no fracture is simple whereas an accompanying fracture makes the dislocation complex. The
most common fracture is a radial head fracture, although coronoid process fracture is also common. The terrible
triad of the elbow is the combination of 1-3:
posterior dislocation
coronoid process fracture
radial head fracture

On this page:
Epidemiology
Pathology
Radiographic features
Treatment and prognosis
Related Articles
References
Cases and Figures
Epidemiology
Elbow dislocations are common, and account for 10-25% of all elbow injuries in the adult population 1.
Pathology
Mechanism

Most elbow dislocations are closed and are most frequently posterior (sometimes posterolateral or
posteromedial) although anterior, medial, lateral and divergent dislocations are also infrequently encountered).
Posterior dislocations typically occur following a fall onto an extended arm, either with hyperextension or a
posterolateral rotatory mechanism 1.
Radiographic features
In most cases plain films suffice for assessment of elbow dislocations, although CT in increasingly used to
pre-operatively assess intra-articular fractures.
Plain film

The dislocation is usually obvious, especially if adequate AP and lateral views are obtained, however the
challenge is in identifying associated fractures.
Although rarely required in practice, a line drawn along the anterior margin of the humerus (anterior humeral
line) and one along the long axis of the radius should intersect near the centre of the capitellum 3.
Report checklist

In addition to reporting the presence of a dislocation a number of features should be sought and commented
upon.
dislocation direction
posterior, posterolateral, posteromedial, lateral, medial or divergent
associated fractures

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most frequently the radial head and coronoid process

other fractures encountered include: lateral condyle, capitellum, olecranon 2
wrist and shoulder may need to be imaged if there is clinical concern
Treatment and prognosis
When elbow dislocation is simple (i.e. no associated fracture) then closed reduction and a brief period (e.g. <2
weeks) of immobilisation at 90 degrees of flexion usually suffices 1,3.
Complex fracture-dislocations of the elbow require operative management, consisting reduction of the
dislocation, management of the fracture and repair of surrounding damaged soft tissues (ORIF). They are far
more likely to have a poor outcome, including secondary osteoarthritis, limited range of motion, instability and
recurrent dislocation as well as pain 1.
Occasionally injury to the brachial artery may be seen (this is more common in open fracture-dislocations) 2.
Related articles
Elbow pathology

elbow anatomy
elbow radiography[+]
MRI of the elbow - an approach
trauma
fractures[+]
dislocations
radial head dislocation (acquired)
elbow dislocation
terrible triad of the elbow
ligamentous[+]
inflammatory[+]
congenital [+]
mechanical[+]
Panner disease (osteochondrosis of the capitellum)

References
1. Dines DM, Lorich D, Helfet D. Solutions for Complex Upper Extremity Trauma. Thieme Medical Pub.
(2008) ISBN:1588905047. Read it at Google Books - Find it at Amazon
2. Marinek B, Dondelinger RF. Emergency Radiology, Imaging And Intervention. Springer Verlag. (2006)
ISBN:354026227X. Read it at Google Books - Find it at Amazon
3. Bridgeforth G, Cherf J. Lippincott's Primary Care Musculoskeletal Radiology. Lippincott Williams &
Wilkins. (2010) ISBN:0781793777. Read it at Google Books - Find it at Amazon
Edit Article Share

Article Information:
rID: 10501
Systems: Musculoskeletal, Trauma
Section: Gamuts
Tags: fractures, elbow
Synonyms or Alternate Spellings:
Posterior dislocation of the elbow

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Posterior elbow dislocation

Dislocation of the elbow
Elbow fracture-dislocation
Fracture-dislocation of the elbow

Cases and Figures

Case 1: posteriorCase 1: posterior

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Case 2: posteriorCase 2: posterior

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Case 3: radial neck fractureCase 3: radial neck fracture

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Case 4: coronoid process fractureCase 4: coronoid process fracture

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Case 5: terrible triad of the elbowCase 5: terrible triad of the elbow

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Case 6: medialCase 6: medial

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Case 7: medial epicondylar fractureCase 7: medial epicondylar fracture

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Case 8: medialCase 8: medial

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Case 9: soft tissue injuries on MRICase 9: soft tissue injuries on MRI

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Case 10: Fracture-dislocation Case 10: Fracture-dislocation

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Case 11Case 11
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