Pediatric emergency medicine trisk 3472 3472
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True elbow dislocation in the pediatric patient is uncommon, despite being the
second most frequently dislocated joint in adolescents and adults. Dislocations of
the elbow are usually accompanied by significant soft tissue and bony damage.
The force and torque of the fall causing the dislocation typically results in
posterior and lateral displacement of the radius and ulna, tearing of the anterior
capsule, and often rupture of the medial collateral ligament as well ( Fig. 111.24 ).
In addition to obvious pain, deformity, and significant swelling, in the setting of
dislocation the affected forearm may appear shortened and the humeral head can
be detected as fullness in the antecubital fossa. A thorough neurovascular
examination is imperative due to the risk of ulnar and median nerve injury and the
potential for trauma to the brachial artery. Ulnar nerve lesions typically occur
when the dislocation is complicated by intra-articular entrapment of an avulsed
medial epicondyle. After initial evaluation, patients should be temporarily
splinted—avoiding hyperextension—prior to imaging to ensure no further
neurovascular injury occurs. The AP and lateral radiographs should be assessed
for the direction of the dislocation and for the presence of associated fractures.
FIGURE 111.24 Elbow dislocation in an 8-year-old girl. A displaced fracture of the medial
epicondyle was evident on the postreduction radiographs.
