Acute Elbow Dislocation and Instability: Update on Diagnosis and Management
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Published:
Aug 29, 2025
Keywords:
Elbow dislocation, elbow instability, elbow, medial instability, lateral instability, posterolateral rotatory instability
Main Article Content
Abstract
Nonsurgical treatment is the most common approach for simple elbow dislocations. After reduction, careful clinical evaluation to identify injured stabilizers is essential. In selected cases, ligament repair or reconstruction is indicated. Outcomes are generally predictable, with restoration of a functional elbow and a low complication rate. The objective of this article is to provide an update on the diagnostic and therapeutic management of acute elbow dislocations.
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How to Cite
Patiño, J. M. (2025). Acute Elbow Dislocation and Instability: Update on Diagnosis and Management. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 90(4), 377-387. https://doi.org/10.15417/issn.1852-7434.2025.90.4.2173
Section
Postgraduate instruction
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References
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4. Gallucci GL, Rellán I, Boretto JG, Alfie VA, Donndorff A, De Carli P. Inestabilidad posterolateral crónica de codo. Reconstrucción ligamentaria. Rev Asoc Argent Ortop Traumatol 2016;81(4):294-301. Disponible en:
https://www.scielo.org.ar/scielo.php?pid=S1852-74342016000400008&script=sci_abstract&tlng=en
5. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am 1986;68(8):1158-63. PMID: 3771597
6. Morrey BF, Tanaka S, An KN. Valgus stability of the elbow: A definition of primary and secondary constraints. Clin Orthop Relat Res 1991;(265):187-95. PMID: 2009657
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8. Patiño JM, Torres Moirano JM. Engaging posterior capitellum fracture and elbow posterolateral rotatory instability: is it always necessary to treat the bone defect? Case Rep Orthop 2020;2020:3260106. https://doi.org/10.1155/2020/3260106
9. Coonrad RW, Roush TF, Major NM, Basamania CJ. The drop sign, a radiographic warning sign of elbow instability. J Shoulder Elbow Surg 2005;14(3):312-7. https://doi.org/10.1016/j.jse.2004.09.002
10. Rhyou IH, Lim KS, Kim KC, Lee J-H, Ahn K-B, Moon SC. Drop sign of the elbow joint after surgical stabilization of an unstable simple posterolateral dislocation: natural course and contributing factors. J Shoulder Elbow Surg 2015;24(7):1081-9. https://doi.org/10.1016/j.jse.2015.01.018
11. O’Driscoll SW, Horii E, Morrey BF. Anatomy of the attachment of the medial ulnar colateral ligament. J Hand Surg 1992;17(1):164-8. https://doi.org/10.1016/0363-5023(92)90135-c
12. Maripuri SN, Debnath UK, Rao P, Mohanty K. Simple elbow dislocation among adults: a comparative study of two different methods of treatment. Injury 2007;38:1254-8. https://doi.org/10.1016/j.injury.2007.02.040
13. Rafai M, Largab A, Cohen D, Trafeh M. [Pure posterior luxation of the elbow in adults: immobilization or early mobilization. A randomized prospective study of 50 cases]. Chir Main 1999;18(4):272-8. [En francés] PMID: 10855330
14. Mayne IP, Wasserstein D, Modi CS, Henry PDG, Mahomed N, Veillette C. The epidemiology of closed
reduction for simple elbow dislocations and the incidence of early subsequent open reduction. J Shoulder Elbow Surg 2015;24(1):83-90. https://doi.org/10.1016/j.jse.2014.08.027
15. Modi CS, Wasserstein D, Mayne IP, Henry PDG, Mahomed N, Veillette CJH. The frequency and risk
factors for subsequent surgery after a simple elbow dislocation. Injury 2015;46(6):1156-60.
https://doi.org/10.1016/j.injury.2015.02.009
16. Raghuwanshi JS, Hassebrock JD, Kozusko S, Dacus AR. The docking technique for medial ulnar
collateral ligament reconstruction. J Hand Surg Am 2025;50(5):627.e1-627.e6.
https://doi.org/10.1016/j.jhsa.2025.01.031
17. Jeon IH, Kim SY, Kim PT. Primary ligament repair for elbow dislocation. Keio J Med 2008;57:99-104. https://doi.org/10.2302/kjm.57.99
18. Nestor BJ, O’Driscoll SW, Morrey BF. Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 1992;74(8):1235-41. PMID: 1400552
19. O’Brien MJ, Lee Murphy R, Savoie FH 3rd. A preliminary report of acute and subacute arthroscopic repair of the radial ulnohumeral ligament after elbow dislocation in the high-demand patient. Arthroscopy 2014;30(6):679-87. https://doi.org/10.1016/j.arthro.2014.02.037
20. Ott N, Harland A, Lanzerath F, Leschinger T, Hackl M, Wegmann K, et al. Locking suture repair versus ligament augmentation-a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow. Arch Orthop Trauma Surg 2022;143(2):857-63. https://doi.org/10.1007/s00402-022-04337-0
21. Ring D, Bruinsma WE, Jupiter JB. Complications of hinged external fixation compared with cross-pinning of the elbow for acute and subacute instability. Clin Orthop Relat Res 2014;472(7):2044. https://doi.org/10.1007/s11999-014-3510-4
22. Schreiber JJ, Warren RF, Hotchkiss RN, Daluiski A. An online video investigation into the mechanism of elbow dislocation. J Hand Surg Am 2013;38(3):488-94. https://doi.org/10.1016/j.jhsa.2012.12.017
2. O’Driscoll SW, Horii E, Morrey BF, Carmichael SW. Anatomy of the ulnar part of the lateral collateral ligament of the elbow. Clin Anat 1992;5(4):296-303. https://doi.org/10.1002/ca.980050406
3. O’Driscoll SW, Jupiter JB, King GJ, Hotchkiss RN, Morrey BF. The unstable elbow. Instr Course Lect 2001;50:89-102. PMID: 11372363
4. Gallucci GL, Rellán I, Boretto JG, Alfie VA, Donndorff A, De Carli P. Inestabilidad posterolateral crónica de codo. Reconstrucción ligamentaria. Rev Asoc Argent Ortop Traumatol 2016;81(4):294-301. Disponible en:
https://www.scielo.org.ar/scielo.php?pid=S1852-74342016000400008&script=sci_abstract&tlng=en
5. Jobe FW, Stark H, Lombardo SJ. Reconstruction of the ulnar collateral ligament in athletes. J Bone Joint Surg Am 1986;68(8):1158-63. PMID: 3771597
6. Morrey BF, Tanaka S, An KN. Valgus stability of the elbow: A definition of primary and secondary constraints. Clin Orthop Relat Res 1991;(265):187-95. PMID: 2009657
7. Patiño JM, Rullan Corona A, Michelini A, Abdón I. Inestabilidad posterolateral tardía del codo como secuela de fracturas de la infancia. Rev Asoc Argent Ortop Traumatol 2011;76(3):268-72. Disponible en: https://www.aaot.org. ar/revista/2011/n3/Rev_Asoc_Argent_Ortop_Traumatol_2011_76(3)_268.pdf?_gl=1*26e08s*_ga*MTkxNjg4NzY0My4xNzQ0OTQ2NjMx*_ga_BFFNBSGNHH*czE3NTEyNDk4NzQkbzUkZzAkdDE3NTEyNDk4NzQkajYwJGwwJ Ggw
8. Patiño JM, Torres Moirano JM. Engaging posterior capitellum fracture and elbow posterolateral rotatory instability: is it always necessary to treat the bone defect? Case Rep Orthop 2020;2020:3260106. https://doi.org/10.1155/2020/3260106
9. Coonrad RW, Roush TF, Major NM, Basamania CJ. The drop sign, a radiographic warning sign of elbow instability. J Shoulder Elbow Surg 2005;14(3):312-7. https://doi.org/10.1016/j.jse.2004.09.002
10. Rhyou IH, Lim KS, Kim KC, Lee J-H, Ahn K-B, Moon SC. Drop sign of the elbow joint after surgical stabilization of an unstable simple posterolateral dislocation: natural course and contributing factors. J Shoulder Elbow Surg 2015;24(7):1081-9. https://doi.org/10.1016/j.jse.2015.01.018
11. O’Driscoll SW, Horii E, Morrey BF. Anatomy of the attachment of the medial ulnar colateral ligament. J Hand Surg 1992;17(1):164-8. https://doi.org/10.1016/0363-5023(92)90135-c
12. Maripuri SN, Debnath UK, Rao P, Mohanty K. Simple elbow dislocation among adults: a comparative study of two different methods of treatment. Injury 2007;38:1254-8. https://doi.org/10.1016/j.injury.2007.02.040
13. Rafai M, Largab A, Cohen D, Trafeh M. [Pure posterior luxation of the elbow in adults: immobilization or early mobilization. A randomized prospective study of 50 cases]. Chir Main 1999;18(4):272-8. [En francés] PMID: 10855330
14. Mayne IP, Wasserstein D, Modi CS, Henry PDG, Mahomed N, Veillette C. The epidemiology of closed
reduction for simple elbow dislocations and the incidence of early subsequent open reduction. J Shoulder Elbow Surg 2015;24(1):83-90. https://doi.org/10.1016/j.jse.2014.08.027
15. Modi CS, Wasserstein D, Mayne IP, Henry PDG, Mahomed N, Veillette CJH. The frequency and risk
factors for subsequent surgery after a simple elbow dislocation. Injury 2015;46(6):1156-60.
https://doi.org/10.1016/j.injury.2015.02.009
16. Raghuwanshi JS, Hassebrock JD, Kozusko S, Dacus AR. The docking technique for medial ulnar
collateral ligament reconstruction. J Hand Surg Am 2025;50(5):627.e1-627.e6.
https://doi.org/10.1016/j.jhsa.2025.01.031
17. Jeon IH, Kim SY, Kim PT. Primary ligament repair for elbow dislocation. Keio J Med 2008;57:99-104. https://doi.org/10.2302/kjm.57.99
18. Nestor BJ, O’Driscoll SW, Morrey BF. Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Am 1992;74(8):1235-41. PMID: 1400552
19. O’Brien MJ, Lee Murphy R, Savoie FH 3rd. A preliminary report of acute and subacute arthroscopic repair of the radial ulnohumeral ligament after elbow dislocation in the high-demand patient. Arthroscopy 2014;30(6):679-87. https://doi.org/10.1016/j.arthro.2014.02.037
20. Ott N, Harland A, Lanzerath F, Leschinger T, Hackl M, Wegmann K, et al. Locking suture repair versus ligament augmentation-a biomechanical study regarding the treatment of acute lateral collateral ligament injuries of the elbow. Arch Orthop Trauma Surg 2022;143(2):857-63. https://doi.org/10.1007/s00402-022-04337-0
21. Ring D, Bruinsma WE, Jupiter JB. Complications of hinged external fixation compared with cross-pinning of the elbow for acute and subacute instability. Clin Orthop Relat Res 2014;472(7):2044. https://doi.org/10.1007/s11999-014-3510-4
22. Schreiber JJ, Warren RF, Hotchkiss RN, Daluiski A. An online video investigation into the mechanism of elbow dislocation. J Hand Surg Am 2013;38(3):488-94. https://doi.org/10.1016/j.jhsa.2012.12.017