The Hip: Preservation, Replacement and Revision

Elbow Dislocations in Children


- See: Elbow Dislocations in Adults:

- Discussion:
    - elbow dislocations in children are a relatively uncommon;
    - peak incidence occurs in adolescence between 11-15 years.
    - posterior dislocations are most common type;
    - posterior dislocation usually results from fall on outstretched hand w/ forarm supinated & elbow extended or partially flexed;
          - coronoid process, which nl resists posterior displacement of ulna, is relatively small in children;
          - anterior capsule of elbow joint is torn by force of the impact transmitted upward thru the ulna and radius;
    - associated injuries:
          - medial epicondyle fracture (most common)
                 - medial epicondyle appears at age 5 yrs;
                 - entrappment of medial epicondyle may be a complication of reduction, which might require open reduction is required;
                 - residual incongruity is another indication for open reduction;
                 - ref: Incarcerated Medial Epicondyle Fracture Following Pediatric Elbow Dislocation: 11 Cases
          - coronoid process fracture
          - radial neck fracture


- Exam:
    - posterior dislocations of elbow in children must be carefully assessed for assoc frx or neurovascular injury;
    - ref: Median nerve entrapment after dislocation of the elbow in children. A report of 2 cases and review of literature.


- Radiographs:
    - ossification of medial epicondyle can be delayed until age 5 yrs, assoc displacement of apophysis of medial epicondyle may be missed;
    - entrapped medial epicondyle may be mistaken for trochlear ossification center;
    - distal humerus epiphyseal separation injuries may be confused w/ elbow dislocations, esp since these injuries are most common in 
           children under 2 years of age;

- Technique of Reduction:
    - surgeon encircles pts arm w/ his fingers (to give countertraction), &, w/ his thumbs, pushes the olecranon downward & foreward;
         - following reduction, elbow is acutely flexed as much as swelling will permit and w/o causing circulatory embarrassment;
    - complications of reduction:
         - coronoid process of ulna becomes locked in the olecranon fossa;
         - periosteum is stripped from posterior surface of humerus & brachialis muscle becomes stretched;
         - w/ reduction portion of medial epicondyle may be incarcerated in joint;
         - w/ posteromedial dislocation, frx of lateral condyle may occur;
         - injury to brachial vessels or ulnar and median nerves may occur;
         - intra-articular entrapment of median nerve may follow close reduction of elbow dislocations in children.

- Post Reduction Care:
    - stability of joint and neurovascular exam is documented;
    - post reduction radiographs:
           - order CT scan if there is a question of entrapped medial epicondyle.
           - references:
                   - Medial epicondyle fractures in the pediatric population
 
    - 3 wks after closed reduction, plaster splint is removed and active exercises are instituted to restore nl range of motion



Untreated posterior dislocation of the elbow in children.

Fracture-separation of the distal humeral epiphysis in young children.

Median nerve entrapment after dislocation of the elbow in children. A report of 2 cases and review of literature.

Fractures and dislocations about the elbow in children. Beaty JH. Instr Course Lect. 1992;41:373-384.

Dislocations of the elbow in children.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, June 17, 2016 1:54 pm