Pediatric Elbow Dislocation

There are five conditions connected to elbow dislocation in children: Pediatric elbow dislocation, Pulled elbow (Nursemaid’s elbow), congenital dislocation of the radial head, Monteggia fracture, and transepiphyseal separation of the distal humerus.

Pediatric elbow dislocation, by itself, occurs in older children between 10-15 years of age. It is rarely seen before the age of 3, and is not a very common injury.

An elbow dislocation in usually posterolateral. There is no relationship between the radial head and the capitellum, but the relationship between the radius and ulna is maintained. Because of this, it is an elbow dislocation and not a Monteggia fracture.

The treatment of the pediatric elbow dislocation is closed reduction and early range of motion exercises.

This condition may have an associated medial epicondyle fracture. You should check if the medial epicondyle fracture is entrapped in the joint or not. If this is the case, the joint will appear incongruous. This fragment may be hard to detect, especially if there is a spontaneous reduction of the elbow by itself. After reduction, if the fragment is still in the joint or if there is substantial fragment displacement, this is an indication for an open reduction internal fixation surgery.

Pulled Elbow is a common injury in young children between the ages of 2-3. When pulling the child’s arm, the child goes in one direction and the parent goes in another, causing the annular ligament to become torn and trapped inside the joint. The radial head may also be subluxed. However, this is not an elbow dislocation. It is a pulled elbow because the child refuses to move the elbow, but the position of the arm of the child will be slightly flexed but pronated. When x-rays are taken, they will be negative.

In order to treat a pulled elbow, it must be reduced. To reduce it, a full supination of the arm followed by flexion will be done. There will be no need for immobilization of the child, and the child should be free to use their arm. In order to know that the injury is reduced, simply give the child a piece of candy- if the child can bend (flex) the elbow in order to get the candy in their mouth, then the elbow is reduced.

This entity can easily be confused with an elbow dislocation. Congenital dislocation of the radial head is usually bilateral and cannot be reduced. With this injury, there will be no significant history of trauma, and the capitellum will look hypoplastic. There will be a posterior dislocation of the radial head and the radius will be bowed and shortened.

Other anomalies should be checked for, and if the condition is symptomatic, a radial head resection will need to be performed in adulthood.

A Monteggia fracture is a proximal 1/3 ulnar fracture and radial head dislocation or subluxation. This condition may be difficult to diagnose, but if the diagnosis is delayed, the treatment will be complicated and there will be even more complications. A posterior interosseous nerve injury should be checked for along with the Monteggia fracture.

The diagnosis is difficult because the fracture of the ulna may not be very apparent, but the relationship between the radial head position to the capitellum should be looked at in order to properly diagnose. The most common type of Monteggia dislocation is an anterior dislocation of the radial head, which is why the relationship between the radial head and capitellum should be checked. In a Monteggia fracture, the radial head is the part that is dislocated, not the elbow. In this way, the relationship between the radial head and the ulna is also interrupted.

When treated, if anatomic alignment of the ulna is not achieved, the radial head may continue to sublux and the ulna will heal in a bad position with the radial head dislocated. If this is the case, an osteotomy of the ulna and open reduction of the radial head will need to be performed.

Differentiating the pediatric elbow dislocation from the transphyseal separation of the distal humerus can be difficult. It is also difficult to diagnose due to the fact that there is no clearly visible ossific centers at the distal humerus at a young age. In elbow dislocation, the olecranon moves posteriorly and laterally, and a pediatric elbow dislocation does not occur in children at 1 or 2 years of age. Transphyseal separation of the distal humerus usually occurs in a younger age group than elbow dislocation does.

In a transphyseal separation of the distal humerus, the distal fragment goes medially, but the radio-capitellar line remains the same.

If transepiphyseal separation of the distal humerus is found, consider child abuse and check for other signs of this.