Surgery for Elbow Dislocation Not Only for Complex DislocationsWhen someone dislocates their elbow, it can be classified as simple or complex. The difference is whether there are any fractures around the elbow or not. If there aren't any fractures, usually the elbow is treated conservatively, without surgery. Most often surgery is only done if the elbow can't be reduced (put back into place) or if the elbow is very unstable.
The elbow is a complicated joint. It moves up and down and side to side. The radial head, where one of the forearm bones meets the elbow, is used to stabilize stress and force that is placed on the elbow. It also helps distribute the weight load. The ligament in the elbow helps hold the bones together and keep them stable. It allows the elbow to bend and straighten out again. If the ligament is torn, it can cause pain and instability in the joint, making it difficult to move. The muscles around the elbow stabilize it, but needs the ligaments to hold the elbow together first. Injury can force the muscle away from the elbow, leading to more destabilization.
When doctors assess a patient for a dislocated elbow, they must do so quickly because timing is important. If an elbow is dislocated, it could be pressing on blood vessels or nerves in the area and if this left too long, could cause further damage. Therefore, if there is any sign of this (numbness, inability to move the fingers) and the elbow is dislocated, it should be reduced as quickly as possible.
X-rays need to be done to rule out any other damage to the bones around the elbow and if there is no further injury, then the elbow can be reduced with the patient under a general anesthetic. After the elbow has been reduced, the doctor will move the elbow around to see if it will dislocate again or if there is a difficulty with moving it. If the elbow can't be stabilized or there seems to be a problem with the range of motion, then surgery will still be needed.
Not many studies have been done comparing the outcomes between patients who had surgery and those who didn't. One done by Josefsson and colleagues didn't find a significant difference although there were a few patients who had surgery who had some trouble straightening out their arm completely and some patients who didn't have surgery who had pain in the elbow for quite a while after.
The author of this article suggested that some patients who wouldn't normally be referred for surgery may do better with surgery than conservative treatment. This would include patients who also tore the stabilizing ligament when injuring the elbow. This allows the surgeon to reconstruct the ligament and provide stability to the elbow. Of course, elbows with fractures do require surgery.
In conclusion, the author writes that even if the elbow has been reduced without surgery, it is important to do a close follow up to ensure the elbow is stable.
Roger P. van Riet. Elbow dislocations. In Current Orthopaedic Practice. November 2008. Vol. 19. No. 6. Pp. 616-620.
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