Management of Adult Elbow Fracture Dislocations

Complex elbow dislocations are typically high-energy injuries that present a challenge to the treating physician, almost always require surgery, and are commonly burdened with complications. Advanced imaging is often helpful to assess the extent of injury and to determine the approach and type of fixation necessary. A methodological surgical approach results in improved outcomes. The authors use an inside-out technique beginning with addressing any coronoid injuries if present, then proceed to the radial head, lateral ligament structures, and finally medial ligaments, if necessary. If elbow stability is in question after all bony and lateral ligamentous structures have been addressed, an external fixator may be applied with or without the repair of the medial ligaments. Early motion is crucial in avoiding postoperative stiffness and contractures; however, maintenance of a stable reduction is paramount.