Dislocation of the elbow are the second highest rate after a dislocated shoulder. The peculiarity of the elbow joint is that the power of the humerus (trochlea) articulates with the ulna and outwards from the unit spherical elevation (eminentia capitata) serves for articulation with the radius. The elbow has, firstly, the simultaneous movement of the two bones of the forearm in the form of flexion and extension of the humerus around the block, and, secondly, the individual rotational (rotator) movement of the radial head, giving inward rotation (pronation) and outward (supination) .
Related strong interosseous ligaments and the annular arm bone usually sprained together and often give back sprains, some at least - and very rare side - front and isolated dislocations of the elbow or the radius. In the mechanism of origin of posterior dislocation of the forearm bones in most cases you can see the effect of over-extension of the elbow during arm action odnoplechego. Olecranon (olecranon) thus becomes the fulcrum of the two bones in the posterior fossa of the shoulder.
When hyperextension (hyperextension) posterior limb at an angle to block the humerus (trochlea) strongly strains the front wall of the bag, tearing her shoulder pineal gland protrudes through the gap of the capsule forward and interconnected annular ligament forearm slide backwards and upwards. This separation of the articular ends of the torn elbow ligament and lateral extending to both sides of the ulnar humeral condyle. Recently, very often internal - often come off and thus provide abundant hemorrhage.
At a young age lower end of the shoulder epiphysiolysis can often simulate a dislocated elbow. If the rear end of the dislocation of the coronal ridge remains still on the block, talking about partial dislocation of the elbow. At full posterior dislocation of the elbow coronary process is shifted to the rear hole. Sometimes, however, he comes off the inside shoulder muscles (m. Brachialis internus).
Symptoms of the elbow posterior dislocation
Elbow straighten an angle of about 140 °, and the joint area extended from front to back. Olecranon (olecranon) will stand sharply posteriorly; furrow over him with strained muscles triceps (triceps); at a pressure of a finger on the finger deep furrow leaves, but not detectable bone shoulder. The head of the beam often even visible to the eye and easily detectable under the skin in the rotational movement of the forearm, posterior to the projection of the humerus. The smooth articular surface of the block is often palpable good front. The relationship of the classical points on the elbow with the palm and the back side - compared with the healthy side violated: instead of an isosceles triangle (at an angle of 140 °), 3 points are almost on a straight line, and, depending on the height of standing olecranon (olecranoni) , the tip of it can be even higher than the line connecting the condyles. The distance to the tip of the latter is increased. Tension resistance remains even in anesthesia, ie. To the obstacle to bending is coronary process, abuts the rear hole on the block and forming a fulcrum for the double-arm lever, which pulls the upper end of the three-headed muscle.
Reduction of dislocation of the elbow (elbow joint) is based on the principle of hyperextension in the types of release coronoid process. Resting his elbow on his knee, the surgeon extends the damaged limb stretches its length and then makes a bend at the elbow. Posterior dislocation of the elbow (elbow joint) sometimes allow the successful reduction even after a fairly long period of time (several months).
Lateral dislocations of the elbow (elbow joint) are usually adjustable variation in the sense of the basic mechanism. If you fall on the outstretched arm is deflected by the end of the arm in the lateral or medial side, the upper end of its dislocating posteriorly and medially or posteriorly and laterally; The first case usually mean normal valgus elbow joint. These dislocations, more complex clinical manifestations yield bias and improper relationship Sensor detection points, followed by torn ligaments and bone margin projections. Accurate detection of difficult at first extensive hemorrhage, enveloping the injury. X-rays are especially useful. Reduction of proceeds from the basic hyperextension and lateral pressure on the misaligned tabs on either side.
Elbow dislocation was reduced under propofol sedation.
Anterior elbow dislocation
Rare anterior dislocated elbow (elbow joint) is usually a fall on the elbow with excessive bending it. There are subluxation when the olecranon (olecranon) worth upёrshis unit of the humerus, and complete dislocation, when he stands in front of the block of the humerus. Often during this happens a fracture of the olecranon. Reduction of them with a large rupture of the capsule is not much difficulty stretching with pressure from front to back on the bent arm.
Diverges dislocation (lux. Cubiti divergent), resulting in the elbow (elbow), with considerable effort due to the introduction of the humerus wedge between the bones of the forearm after breaking interosseous and annular ligament is very rare. Reduction of fractures due to the large bags easily. In difficult cases, each requires a separate forearm bone reposition: straightening and traction - ulna, direct pressure to the rotation - radius.
An isolated or separate dislocated elbow (elbow joint) posterior arises from falling to straighten and allotted over the forearm. Determined almost the same clinical signs that posterior dislocations of of both bones. But by shifting up the medial bone in the lateral stays in place, the hand forms a medial shortening and corner open inwards (cubitus varus). The rotation of the forearm inward (pronation) and outward (supination) - possible.
Dislocation of the ulna posteriorly reduce a traction inside-outside (supine) forearm while straightening the lateral angle and straightening the elbow. All three recent dislocation of the elbow (elbow joint) is very rare. The exact definition of facilitated fluoroscopy. From isolated dislocation of the elbow (elbow joint) is much more important is the dislocation of the head of a separate beam which originates from a direct blow from behind to front, or from the outside. But it can also occur in indirect force - due to the strong pronirovaniya forearm (wringing his hands), with the annular ligament is torn. Most often it turns dislocated beam forward and outward, when the head of his lies over the outer humeral condyle. Clinically - the forearm is in a position of flexion and pronation and forms an angle with the shoulder, open outwards - cubitus valgus. Head detectable in the elbow - in front of or over the outer condyle shoulder - and learn the shape and rotation of pronation and supination while. Rear Sensor detection point of the elbow are not displaced. This dislocation of the elbow (elbow joint) often precedes the fracture of the upper third of the ulna. Reduction of the elbow is usually easy to succeed in extension, outward rotation (supination) and pulling the forearm and direct pressure on the head. But just as easily head pops up again when movements. Firm hold it in place hinder the bag ruptured and the annular ligament. Hold the head in place best contributes to fixing bandage when rotating inwards (pronirovanii) and flexion of the forearm at a very acute angle at the elbow. If irreducible dislocation of the elbow (elbow joint) has to eliminate obstacles quickly - sometimes even head resection.