The Complex Dislocations of the Elbow

Abstract

The elbow is the second most frequently dislocated major joint in adults (following the shoulder). Most elbow dislocations do not have an associated fracture and therefore have been termed a simple dislocation [1]. Fortunately, early mobilization following a closed reduction has a low risk of redislocation and generally good long-term results [2, 3]. When an elbow dislocation is associated with a fracture this injury has been termed a complex dislocation [5, 6, 7]. These injuries often require surgical treatment to render the elbow stable enough to allow early motion. The presence of intra-articular fractures compromises the intrinsic stability of the elbow and increases the risk of recurrent instability and post-traumatic arthritis. In fact, these injuries historically have had such a poor outcome that when a posterior elbow dislocation is associated with the radial head and coronoid fracture this injury has been referred to as “ the terrible triad”. In this paper the relevant anatomy, biomechanics, pathophysiology, and treatment approach to these difficult injuries will be reviewed.