SAQ 109 – Orthopaedics – elbow dislocation reduction

Question 6. elbow dislocation reduction.

a. Early complications

• Brachial artery dissection or occlusion.
• Median nerve neuropraxia.
• Compartment syndrome.
• Septic joint if open.
• Unstable elbow.
• Adverse drug reaction to treatment.
• Pain, though vascular, neurological, compartment, infection, and instability answers are stronger.

b. Analgesic or sedative regimen

• Urgent reduction is needed to reduce pain and complications.
• Ketamine 0.5-1 mg/kg IV.
• Midazolam IV titrated to sedation, for example 2 mg aliquots.
• Interscalene local anaesthetic block with lignocaine or bupivacaine.
• Bier's block technique.
• Avoid propofol or general anaesthesia in this unfasted patient with significant morphine already on board.

c. Reduction steps

• Assistant applies counter-traction to the arm.
• Disengage the joint with downward pressure on the proximal forearm.
• Apply longitudinal traction.
• Consider firm pressure over the olecranon.
• Splint at 90 degrees flexion and elevate.
• If unsuccessful because of intra-articular fragments, arrange operative reduction.