Elbow Fracture-Dislocation Reduction and Management

Post-Reduction Assessment and Management

• The American College of Radiology recommends performing stress fluoroscopy immediately after reduction to quantify instability, with <10° of joint widening indicating slight instability, >10° indicating moderate instability, and frank redislocation indicating gross instability requiring surgical fixation 1
• The American College of Radiology suggests testing joint stability under fluoroscopy at full extension, 30° of flexion, and with varus/valgus stress in pronation and supination 1
• Patients with moderate instability (>10° widening) demonstrate significantly worse Mayo Elbow Performance Scores compared to those with slight instability, according to the American College of Radiology 1
• Frank redislocation on stress testing requires immediate surgical fixation, as recommended by the American College of Radiology 1
• Initiate active finger motion exercises immediately to prevent hand stiffness, which is functionally disabling, as suggested by the American College of Radiology 3

Critical Pitfalls to Avoid

• Do not assume stability after reduction, as patients with moderate instability (>10° widening) demonstrate significantly worse Mayo Elbow Performance Scores compared to those with slight instability, according to the American College of Radiology 1
• Do not miss coronoid fractures, as they indicate severe instability and require CT imaging for identification, as noted by the American College of Radiology 2