Elbow Posterolateral Fracture Dislocation

Aka: Elbow Posterolateral Fracture Dislocation, Terrible Triad of the Elbow, Fracture Dislocation of the Elbow

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II. Pathophysiology

  1. Terrible Triad of the Elbow (Posterolateral Fracture Dislocation)
    1. Posterior Elbow Dislocation AND
    2. Radial Head Fracture AND
    3. Coronoid Process Fracture
  2. Associated injuries (responsible for instability)
    1. Elbow Ulnar Collateral Ligament Injury (Medial collateral ligament tear)
    2. Joint capsule injury
    3. Lateral collateral ligament tear
  3. Mechanism:
    1. Fall on Outstretched Hand
    2. Other contibuting factors
      1. Axial load
      2. Valgus stress
      3. Posterolateral rotation

III. Symptoms

  1. Elbow Pain
  2. Clicking
  3. Swelling
  4. Decreased elbow range of motion

IV. Signs

  1. Unstable elbow on reduction (varus and valgus)
  2. Other associated injuries
    1. Ulnar Nerve injury (unable to abduct fingers)
    2. Distal radioulnar joint dislocation

V. Exam

  1. See Elbow Exam
  2. See Hand Neurovascular Exam

VI. Imaging

  1. Elbow XRay
    1. First-line study which is typically sufficient for diagnosis
  2. Wrist or Forearm XRay
    1. Consider if associated distal injury is suspected
  3. CT Elbow
    1. May be indicated for surgical planning

VII. Management

  1. Elbow closed reduction
    1. Performed under Procedural Sedation
    2. Apply posterior Long Arm Splint
    3. Obtain post-reduction xrays
  2. Operative management
    1. Most patients will undergo surgical repair (e.g. radial head arthroplasty, coronoid repair, ligament repair)

VIII. Complications

  1. Chronic elbow instability
  2. Post-Traumatic Arthritis

IX. References

  1. Kiel (2021) Crit Dec Emerg Med 35(9): 16-7

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