Associated Injuries

Associated injuries in elbow dislocations are very common (9-11). Fractures of the radial head and neck occur in 10% of cases due to compression axial load at the radiocapitellar joint. Avulsion fractures of the medial or lateral epicondyle occur in 12% of cases and fracture of the coronoid process has been noted in 10% of elbow dislocations.

In adolescents, it is sometimes difficult to diagnose fractures of the medial epicondyle (12), which may have intra-articular extension and result in posttrau-

matic arthritis. Medial epicondylar fractures can also predispose to secondary dislocation as a result of the loss of integrity of the medial collateral ligament (13).

Osteochondral fractures probably occur more often than they are diagnosed, while intra-articular fractures of the capitellum are rare.

Associated injuries at other sites—such as fractures or dislocations of the distal radius (Fig. 3) or ulnar styloid, perilunate dislocations, and shoulder injuries—are found in 12% of elbow dislocations and should always be suspected.

Significant soft tissue swelling leading to high compartmental pressure can compromise the neurovascular structures as well as causing displacement of the bones. Neurological stretch injuries can also be noted.

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