pem pearl: Elbow dislocation reduction Techniques
I had one patient in residency with an elbow dislocation and it was a 94yo lady. Since then I've seen about 5 kids with elbow dislocations, 2 in the last week. I thought this may be a good time to review the various ways an elbow can be reduced.
This article from Annals of Emergency medicine discusses elbow dislocations and 7 different techniques for reducing them. From my anecdotal, still very small n, ortho normally performs the "Leverage" technique (your elbow in the patient's antecubital fossa) and I had found most success with simple traction-countertraction. Until this last week. This is when I learned of the "Hanging-arm technique" (thanks to Mahdika via Ashley). See the image below. This review cites an article from 1957 noting 20 successful reductions (without anesthesia- yikes) with no complications reported. It also says it takes a bit more time (1-10 minutes of traction), but again, from my very small n with this technique (1), it took me 5-10 minutes struggling with other attempts/techniques and once in position, the hanging arm technique took maybe 10 seconds.
Bottom line: consider the hanging-arm technique for elbow dislocations. Note- I did not prone my most recent patient- once sedated with ketofol we sat him up straight and put his elbow over the bedrail hanging at 90 degrees and applied traction while flexing the hand back toward his body.
This article from Annals of Emergency medicine discusses elbow dislocations and 7 different techniques for reducing them. From my anecdotal, still very small n, ortho normally performs the "Leverage" technique (your elbow in the patient's antecubital fossa) and I had found most success with simple traction-countertraction. Until this last week. This is when I learned of the "Hanging-arm technique" (thanks to Mahdika via Ashley). See the image below. This review cites an article from 1957 noting 20 successful reductions (without anesthesia- yikes) with no complications reported. It also says it takes a bit more time (1-10 minutes of traction), but again, from my very small n with this technique (1), it took me 5-10 minutes struggling with other attempts/techniques and once in position, the hanging arm technique took maybe 10 seconds.
Bottom line: consider the hanging-arm technique for elbow dislocations. Note- I did not prone my most recent patient- once sedated with ketofol we sat him up straight and put his elbow over the bedrail hanging at 90 degrees and applied traction while flexing the hand back toward his body.
