Elbow Dislocation Risks: Nerves, Blood Vessels & Bone Damage

Elbow dislocation (usually posterior) is a high-energy injury with significant neurovascular risk due to the tight anatomy of the cubital fossa.

Neurovascular Injuries

Bony & Soft Tissue Injuries

• Fractures: Radial head/neck (40%), coronoid process (10–15%), medial epicondyle (avulsion), capitellum.
• Ligaments: MCL (valgus instability), LCL complex (varus/posterolateral rotatory instability).
• Cartilage: Chondral/shear injuries → post-traumatic arthritis.

Management Priorities

1. Reduce urgently (conscious sedation) → assess neurovascular status pre/post.
2. Vascular injury: If pulseless post-reduction → emergent angiography/CTA ± exploration.
3. Nerve injury: Most are neurapraxias (recover in 3–6 months). Monitor; explore if no recovery by 3 months or if laceration suspected.
4. Stability: Test varus/valgus at 30° flexion. Stable → early motion. Unstable ± fracture → ORIF ± external fixator.

Post-reduction: splint 90° flexion 1–2 weeks, then early ROM. Serial neurovascular checks.

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Structure	Injury Mechanism	Clinical Consequence
Ulnar nerve	Traction/compression at cubital tunnel; entrapment in medial epicondyle fracture	Thenar wasting, claw hand (4th/5th digits), sensory loss ulnar 1.5 digits, weak grip
Median nerve	Anterior interosseous branch compression; rare complete median injury	Weak pronation, FDP/FPL palsy (AIN); thenar wasting, sensory loss lateral palm if complete
Radial nerve	Less common; stretch at spiral groove	Wrist drop, sensory loss dorsal web space
Brachial artery	Tear/thrombosis from stretch or medial epicondyle fracture fragment	Absent radial pulse, cool hand, pain, paresthesia → limb ischemia (emergency)