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CASE REPORT : ELBOW DISLOCATION

Histy Annisa Hilmy Nur


111 2015 2248

Supervisor : dr. M. Ali Hasti, Sp.OT


Advisor : dr.Ricky Tambunan
Patient’s Identity
• Name : Mr. A
• Age :27 years old
• Sex : Male
• Address : Dusun Pongsamelung
• Work : Contruction workers
• Date of admission : November 18, 2017
• Medical record : 139316
HISTORY TAKING
• Main Complain : Pain at left elbow
• Anamnesis : Patient come to the emergency room A.
Makkasau with complaints of pain in the left elbow about 4
hours ago before admission to hospital. the patient
complained that him elbow difficult to move. Patient go to
medicaster first, before come to hospital.
• Mechanism of Trauma : The patient fall from the about 3-4
meters height when he’s working. He rolled and stumbled to
the ground
• History of loss of consciousness (-), history of nausea and
vomiting (-), history of headache (-).
GENERALIST STATUS
• Moderate ill/Adequat Nutrition/Compos Mentis, GCS 15
• Blood Pressure : 120/80 mmHg
• Heart Rate : 88x/i
• Respiratory Rate : 20x/i
• Temperature : 36,5oC
LOCALIZED STATUS
Left Elbow Region
Look Deformity (+), swelling (-), hematoma (-),
wound (-)
Feel Tenderness (+)
Move Active and passive movement of elbow joint
limitted due to pain
NVD Good sensibility, pulsation radialis artery and
brachialis artery are palpable, CRT <2
seconds
CLINICAL FINDING
RADIOLOGICAL FINDING
LABORATORY FINDING
Pemeriksaan Hasil Nilai normal

WBC 8,9 4.00-10.0

RBC 4,3 3.80-6.50

HGB 14,1 11.5-17.0

HCT 41,3 37.0-54.0

PLT 162 150-500

CT 10’58” <15’00’’

BT 1’49” 1’00”-3’00”
RESUME
A man 34 years old, admitted to Andi
Makkasau Hospital with main complaints of
pain in the left elbow about 4 hours ago
before admission to hospital, the patient also
complained the him elbow difficult to move.
The patient fall from the about 3-4 meters
height when he’s working. He rolled and
stumbled to the ground.
History of loss of consciousness (-), history of
nausea and vomiting (-), history of headache (-
).
Generalist status : normal
RESUME
Generalist status : normal

Localized status: left elbow

Look : deformity (+), swelling (-), wound (-).

Feel : tenderness (+).

Move : limitted due to pain.

NVD : Good sensibility, pulsation brachialis


artery and radialis artery are palpable, CRT <2
seconds
DIAGNOSIS

CLOSED DISLOCATION LEFT ELBOW


JOINT
• Non operatif • Operatif : Close Reduction
1. Non medikamentosa
• Education
• Splint Imobillization
2. Medikamentosa :
• IVFD RL 20 tpm
• Ketorolac inj. 1amp/8h/iv
• Ranitidin inj. 1amp/12h/iv
ANATOMY OF ELBOW
OSTEON
ELBOW DISLOCATION
DEFINITION

Elbow joint dislocation is the circumstances


in which the bones forming the elbow joint are
no longer anatomically related, or the release of
the head from the bowl, dislocation is an
emergency that requires immediate relief.
EPIDEMIOLOGY

• Gender

Dislocations on the elbows are more common in males


than in females

• Age

Dislocations are more common in adulthood, with the


same strength in children more frequent supracondylar fractures
in the distal humerus.
Etiology

An elbow dislocation usually occurs when a person falls


and occurs when his hands are stretched. When the hand
touches the ground, the pressure gets to the elbow. There is
usually a reversal of this style. This elbow dislocation can occur
during a car accident and the elbow is swiveled out of the joint.
Elbow dislocations can occur in car accidents when passengers
hold. The pressure is extended to the arm so that dislocations
can occur at the elbow.
ELBOW dislocation classification
CLINICAL MANIFESTATION

• Moments after the incident of the patient Refute his forearm with
the other hand. Deformity and swelling of the elbows are usually
very real.
• The patient maintains his elbow to not move in the flexion position.
• Direction of dislocation most often to the posterior but can also
occur laterally or medial.
• In the most dislocated soft tissue damage occurs in the form of: tear
joint capsule and even brachial artery, can also occur fraktur.
• If the dislocation to the lateral or medial ligament will extend even
rupture, ovulsion of the tendon of the plexus and the medial
epicondyle.
DIAGNOSIS
(ANAMNESIS)
• Mechanisms : when falling and extension and abduction of
the arm (posterior) or direct flexion of the elbow (anterior)
• Pain, focus around the elbow joint
• Limitations in motion
DIAGNOSIS
(PHYSICAL EXAMINATION)
DIAGNOSIS
(PHYSICAL EXAMINATION)
Lay a hand gently over the
elbow to detect warmth,
comparing to contralateral
side. Palpate the following
structures, evaluate pain
Olecranon can be palpable
in the back.
Triceps prominen
DIAGNOSIS
(PHYSICAL EXAMINATION)
TREATMENT
• Acute : Closed Reduction
• Stable : Splint for 7-10 day
• Unstable : Splint for 2-3 weeks
• Open Reduction for irreducible dxs and/or ORIF fxs
• Hinged External fixation for grossly unstable elbows
TREATMENT

• Parvin's method: the patient


is in a prone position on the
bed, then doing the wrist
traction downward in a few
minutes. When the olecranon
shifts in the distal direction,
raise the upper arm.
• In Meyn and Quigley's
method: the forearm is
hanging beside the bed, do
the traction downward on the
wrist, the reduction of
olecranon by using the other
hand.
THANK YOU