II. General

  1. Common injury, usually posterior

III. Etiology

  1. Fall on Outstretched Hand with elbow extended

IV. Signs

  1. Obvious elbow deformity
  2. Abnormal alignment of olecranon and both epicondyles
    1. Elbow flexed to 90 degrees
    2. Assess alignment of these 3 points at elbow
      1. Normal: equilateral triangle
      2. Dislocated: straight line
  3. Radial Head Fracture easy to feel at lateral epicondyle
    1. Vascular compromise unlikely if present

V. Differential Diagnosis

  1. Supracondylar Fracture
  2. Medial Epicondyle avulsion Fracture
  3. Radial Head Fracture

VI. Management: Reduction (As soon as possible)

  1. General anesthetic usually unnecessary
  2. Straight Traction
    1. Traction at wrist, gentle and steady
    2. Countertraction at Shoulder (sling under axilla)
    3. Extension at elbow to unlock olecranon
  3. Parvin's Method
    1. Patient prone, with arm over end of table
    2. Downward traction at wrist
    3. Allow several minute wait
    4. Gently lift arm upward (often reduces dislocation)

VII. Management: Post-Reduction

  1. Immobilize elbow in molded posterior plaster splint
    1. Splint elbow at 90 degrees flexion
      1. Allows ligament and capsular healing
    2. Splint for 3 weeks
  2. Gentle Range of motion after Splinting
    1. Never force range of motion (worsens injury)
    2. Temporary stiffness is common

VIII. Prognosis

  1. Full elbow Range of motion may take months
  2. May have some residual restriction in range of motion
    1. Often minor restriction
    2. Does not interfere with function

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