Diagnosis A Classification

In children the term pulled elbow refers to the association between the radius and the annular ligament, an injury that is usually a result of joint hypermobility or ligamentous laxity. The entity of congenital radial head dislocation has also been described.

The main classification of acute elbow dislocations corresponds to the direction of the proximal radioulnar joint and olecranon displacement in relation to the distal humerus.

1. Posterior Dislocation

This is the most common type of elbow dislocation, where the proximal radioulnar joint dislocates posteriorly to the distal humerus. It can be medial or lateral, but this is irrelevant to the final treatment.

2. Anterior Dislocation

This is a very a very uncommon injury of the elbow, where the proximal radioul-nar joint dislocates in front (anteriorly) of the distal humerus. It is usually seen in children (7), while in adults it is usually associated with an olecranon fracture.

3. Divergent Dislocation

This is a rare injury of the elbow, where the proximal radioulnar joint is disrupted with consequent rupture of the interosseous membrane, resulting in ante-

Divergent Elbow Dislocation
Figure 2 Circle-like pattern injury of the elbow dislocation. First the lateral unlar collateral ligament is ruptured; then the rest of the lateral ligamentous structures and the anterior capsule are torn; and finally the medial posterior and ulnar collateral ligament rupture.

rior dislocation of the radius and posterior dislocation of the olecranon in relation to the distal humerus. These injuries usually occur after high-energy trauma, but they can also be seen in cases of annular ligamentous insufficiency or in bony erosive conditions like rheumatoid arthritis (8).

Pure medial or lateral dislocations are likewise unusual.

Elbow dislocations can also be subdivided in to (1) simple dislocations without fracture and (2) complex ones with associated fractures. This subdivision is significant for the choice of treatment and for the prognosis of the final functional outcome.

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