Elbow Dislocations, Fracture-Dislocations, and Terrible Triad Injuries

Journal and index pages often block iframe embedding. This reader keeps the evidence details in Orthonotes and leaves the source page one click away.

Abstract

(1) The incidence of elbow fracture-dislocations is increasing in older adult patients. This leads to important surgical considerations, such as fixation in poor quality osteoporotic bone and the often-fragile soft tissue envelope. (2) When assessing and managing dislocations and fracture-dislocations of the elbow, a key consideration for all patients is to define the important soft tissue and bony components of the injury to address elbow and/or forearm instability. An understanding of the frequently encountered injury patterns can be useful when determining the optimal management, with the coronoid component often being key to achieving stability. (3) Diagnosis routinely is made based on plain radiographs of the elbow, with further imaging almost universally indicated for better defining the complexity of the bony components of the injury (computed tomography) and/or for determining the presence of an important associated soft tissue injury (magnetic resonance imaging, ultrasonograpy). (4) Nonoperative management is the mainstay for isolated simple elbow dislocations in patients of all ages, with one exception: the rare type 4 injury. Although nonoperative management has been described for complex fracture-dislocations of the elbow, it often is reserved for lower demand older adult patients for whom the risk of surgery outweighs the benefits. A painful and/or stiff elbow is likely to be the outcome following nonoperative treatment. (5) Surgical management is the mainstay of treatment for elbow fracture-dislocations and often entails addressing the bony components of the injury with fixation or replacement, along with repair of the ligamentous components, to allow restoration of elbow stability and early active range of motion with avoidance of splinting