Elbow dislocation and radial-head fracture — Rapid

Synopsis

Recognise elbow dislocation and radial-head fracture, identify vascular and nerve threats, achieve safe reduction and post-reduction stability assessment, and restore motion without missing complex instability.

Posterior elbow dislocation produces obvious deformity and loss of normal olecranon relationships, but associated fractures define whether it is simple or complex.
Document radial and ulnar pulses, refill, median and anterior interosseous, ulnar and radial motor and sensory functions before and after reduction.
Obtain AP and lateral elbow radiographs before reduction unless perfusion or skin is threatened; image the full forearm when another injury is suspected.
Perform prompt controlled reduction under adequate analgesia or sedation, avoiding repeated attempts when fracture or entrapment is likely.
After reduction, repeat neurovascular findings, obtain radiographs and assess stability through a specialist-directed safe arc.
A stable simple dislocation uses brief support followed by early guided motion; prolonged casting causes marked stiffness.
Radial-head fracture treatment depends on displacement, mechanical block, comminution and associated instability, not fragment size alone.
Wrist pain or distal radioulnar tenderness with radial-head fracture requires assessment for interosseous-membrane disruption.
Open injury, terrible triad, irreducibility, vascular compromise or unstable post-reduction joint needs early operative management.

Key red flags

A cool hand, absent pulse, expanding antecubital haematoma or progressive neurological deficit needs immediate reduction and orthovascular action.

An open wound, severe skin tenting, irreducible joint or fracture-dislocation requires urgent operative review rather than repeated force.

Radial-head fracture with coronoid fracture and dislocation forms the terrible triad and has high recurrent instability risk.

Painful blocked forearm rotation after reduction may indicate displaced radial-head fragment or an Essex-Lopresti-type longitudinal forearm injury.

Posterior dislocation

Painful deformity with prominent olecranon and shortened forearm follows a fall on the outstretched hand.

Terrible triad

Dislocation with radial-head and coronoid fractures signals complex instability and operative-level review.

Brachial-artery threat

Coolness, pulse loss, refill delay or expanding antecubital swelling requires immediate action.

Longitudinal forearm injury

Wrist pain and distal radioulnar instability with radial-head fracture suggests an Essex-Lopresti pattern.

Investigation priorities

AP and lateral elbow radiographsFirst step

Confirm direction, radial-head and coronoid fracture and joint congruence.

Management branches

Initial careDefine simple versus complex injury

A deformed or acutely painful elbow follows trauma.

Give analgesia, inspect skin and document pulses and named nerve functions.
Obtain AP and lateral views unless urgent tissue rescue takes priority.
Identify associated radial-head, coronoid, olecranon or forearm injury and prepare a monitored reduction.

RecoveryMove early when stability permits

A congruent stable joint or definitively repaired complex injury is established.

Use brief support and begin guided flexion, extension and rotation within prescribed limits.
Treat radial-head fracture according to mechanical block and associated stability.
Monitor stiffness, instability, nerve recovery and wrist symptoms through follow-up.

Key medicines

Paracetamol for adult elbow painGive 500 mg to 1 g orally when required, separated by at least 4 hours and limited to four doses or 4 g in 24 hours.Reduce the limit for low body weight or hepatic risk and total all combination medicines.

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