Elbow Dislocation
Simple & Complex
Jacksonville, FL
The elbow is the second most commonly dislocated joint in adults — a fall onto an outstretched arm drives the forearm bones out of alignment with the humerus. R. David Graham, MD at JOI manages both: simple dislocations reduced and mobilized early, complex fracture-dislocations (terrible triad) addressed surgically. Ligament stability is assessed after every reduction.
- Simple dislocation: closed reduction, assess stability, early motion
- Complex (terrible triad / fracture-dislocation): surgical — Dr. Graham manages both
- LUCL and MCL assessed under anesthesia after every reduction
- Terrible triad = elbow dislocation + radial head fracture + coronoid fracture
- Early motion after simple dislocation — prolonged immobilization causes stiffness
- Hinged brace for unstable simple dislocations — controlled early motion
Elbow stiffness is the most common complication after dislocation — both from the injury and from over-immobilization. The goal is the earliest stable motion that the injury pattern allows.
Understanding Elbow Dislocation
Simple vs Complex —
Two Very Different Injuries
Elbow dislocation occurs when the ulnohumeral joint is disrupted — the forearm bones (radius and ulna) dislocate from their articulation with the distal humerus. Posterior dislocation is by far the most common, occurring from a fall onto an outstretched hand with the elbow partially extended. The lateral ulnar collateral ligament (LUCL) fails first, followed by the posterior capsule, and in complete dislocations the medial collateral ligament (MCL) as well.
Simple dislocation: no associated fractures. Closed reduction is performed under sedation or regional block, followed by stability assessment through range of motion. If the elbow is stable through most of the functional arc after reduction, early protected motion is initiated — typically in a hinged brace that prevents the last few degrees of extension (where instability is greatest) while allowing flexion-extension within the stable range.
Complex dislocation: fracture-dislocation, most importantly the "terrible triad" — elbow dislocation plus radial head fracture plus coronoid fracture. This combination disrupts virtually every stabilizing structure of the elbow simultaneously. Closed management is not reliable — surgical repair and fixation are required. Dr. Graham manages both simple and complex elbow dislocations, including terrible triad reconstruction.
- ✓ Simple dislocation: closed reduction → stability assessment → early motion
- ✓ Unstable simple: hinged brace in stable arc → motion within stable range
- ✓ Terrible triad: surgical — radial head fixed or replaced, coronoid fixed, LUCL repaired
- ✓ LUCL assessed every case post-reduction — PLRI if left unaddressed
- ✓ MCL assessed — MCL repair occasionally needed for valgus instability
- ✓ Early motion in all cases — stiffness is the primary complication risk
Treatment
Reduction, Stability Assessment, Early Motion
Scroll the table sideways to see all columns
| Dislocation Type | Management |
|---|---|
| Simple — stable after reduction | Posterior splint 5–7 days for swelling; hinged brace; active range of motion begins at 1 week. No prolonged immobilization — stiffness risk is significant. Full extension allowed as stability confirms. |
| Simple — unstable after reduction (drops into dislocation in last 20–30° extension) | Hinged brace blocking the unstable arc. Active motion within stable range. Extension progressively increased over 4–6 weeks as ligaments heal. Surgical stabilization if instability does not resolve. |
| Terrible Triad (dislocation + radial head + coronoid) | Surgical: coronoid fragment fixed (screw or suture), radial head fixed (ORIF) or replaced (arthroplasty), LUCL repaired with suture anchors. Sequential reconstruction from inside out. Stability confirmed under fluoroscopy before closure. Hinged brace post-op; early motion protocol. |
| Associated LUCL tear (confirmed on exam or intraoperatively) | LUCL repair with suture anchors when PLRI (posterolateral rotatory instability) confirmed. Prevents ongoing instability that would otherwise require later reconstruction. See LUCL page. |
FAQs
Frequently Asked Questions
Related Conditions
Next Steps
Elbow dislocation reduced —
stability needs to be confirmed.
Elbow dislocation is not simply reduced and discharged. Ligament stability assessment after reduction determines the post-reduction protocol and whether surgical repair is needed. Early evaluation produces better outcomes.
Jacksonville Beach, FL 32250
Walk-ins welcome for elbow injuries via JOI Now.