Elbow Case 4 ED Management
Reduction requires proper sedation and analgesia. Reduction is accomplished with an assistant stabilizing the humerus while steady longitudinal traction is applied at the wrist. A "clunk" should be appreciated as the elbow reduces; the elbow then should be flexed to 90°. Apply a posterior mold to the elbow in 90 degrees of flexion with the hand in neutral position, then place the patient in a sling. An alternative reduction technique is the Parvin method. Place the patient prone with the forearm hanging down off the bed with 5-10 lbs of weight hanging off the wrist. Reduction should occur within 15-20 minutes. Medial and lateral dislocations are treated much like posterior dislocations.
Reduction of anterior dislocations is accomplished with distal stabilization of the wrist while applying posterior force to the forearm (while an assistant stabilizes the humerus).
Consult orthopedics for open dislocations or those with associated fractures. Otherwise, follow-up can be more routine after reduction.