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.

Key red flags

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

Posterior dislocation

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

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.

RecoveryMove early when stability permits

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

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.

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