- See: Elbow Dislocations in Adults:
- 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;
- Open Reduction Internal Fixation of a Medial Epicondyle Avulsion Fracture With Incarcerated Fragment.
- Incarcerated Medial Epicondyle Fracture Following Pediatric Elbow Dislocation: 11 Cases
- coronoid process fracture
- radial neck fracture
- 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.
- 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.
- 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.