Matthew Varacallo

Pediatric Elbow Dislocations: Acute Management

Traumatic elbow dislocations are uncommon in children, and account for only about 3–6% of all elbow injuries [1]. Overall, however, the elbow is the most commonly dislocated major joint in the pediatric population, and represents up to 25% of all elbow injuries in some series [2]. The injury frequently occurs with an associated fracture or avulsion injury in as many as 75% of children in one study [3], most commonly involving the medial epicondyle [4–6]. Open injuries are rare [3]. The peak incidence of elbow dislocation occurs during the second decade of life, and it is more commonly seen in males [7] and are most commonly the result of a fall onto an outstretched hand. Elbow dislocations are becoming increasingly more common in association with various sport-related activities, especially contact sports, such as wrestling and football [8]. These injuries rarely occur in children younger than 3 years of age; in this age group, a transphyseal fracture, an injury associated with child abuse, may appear radiographically to the inexperienced physician as an elbow dislocation.

Physical Examination of the Pediatric Elbow

Pediatric elbow injuries often present a diagnostic dilemma for the treating physician. The unique anatomy of the elbow in the growing child along with the narrow therapeutic window and relatively high complication rates associated with certain types of fracture patterns creates a challenging diagnostic environment for the clinician. Moreover, injury patterns change with the growth and development of the elbow into adolescence and young adulthood. Understanding the context and chronicity of the injury helps guide the clinician through a comprehensive physical examination and establishes the appropriate diagnostic framework to successfully treat pediatric and adolescent patients presenting with a wide variety of elbow pathology.