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肘关节不稳定

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Elbow ligamentous and bony instability, including dislocation and the terrible-triad pattern.

Updated Aug 2026
一幅手绘插图，描绘了一个无脸的人在一场摔倒后肘部无力支撑，用手托住肘部。
肘关节韧带——尺侧和桡侧副韧带是主要的稳定结构。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

您可能会感觉肘关节有脱位感。这种感觉通常发生在您举手过头顶或对抗阻力时。您的关节可能会感觉松动或不稳定。您可能会在手臂外侧感到尖锐的疼痛。这种疼痛通常源于维持骨骼连接的韧带拉伤。这些韧带作为静态稳定结构，以保持关节的稳固。

疼痛可能在日常活动中加剧。例如，伸手到背后扣内衣可能会引发不适。塞衬衫下摆可能会感到困难或疼痛。您可能会在早晨刚醒来时感到僵硬。这种僵硬通常会随着您白天活动手臂而缓解。然而，过度用力可能会导致疼痛复发。

如果您曾经发生过脱位，您可能会感到一种即将再次脱位的预感。您的肘关节可能会突然无力。如果损伤涉及多条韧带，这种情况更为常见。单纯性脱位通常通过休息和仔细监测即可良好愈合。但涉及关节前后方的复杂损伤需要更多关注。您也可能感到肘关节内侧疼痛。

有些人将不稳定感与网球肘混淆。如果您在外侧肘骨处有持续性疼痛，可能与韧带松弛有关。在这种情况下，标准的网球肘治疗方法可能无效。您也可能感到关节深处的疼痛。如果软骨因不稳定而受到刺激，就会发生这种情况。

夜间疼痛也是可能的。您可能会发现很难侧卧在患侧睡觉。手臂的重量会牵拉受伤的韧带。这会导致影响休息的酸痛。您可能会在醒来时感到肘关节僵硬和酸痛。

在严重的病例中，症状可能会持续存在。您可能会经历持续的疼痛、僵硬或不稳定感。创伤性关节炎可能会随时间发展，加重不适。如果您的症状在保守治疗后没有改善，您的外科医生将讨论进一步的选项。我们的目标是恢复稳定性，以便您可以安全地恢复正常活动。

实际发生了什么

您的肘关节依靠骨骼、韧带和肌肉的精确平衡来保持稳定。可以将您的韧带想象成将关节连接在一起的强韧绳索。这些绳索与您的肌肉协同工作，防止骨骼移位。当这些稳定结构受损时，您的肘关节可能会感觉松动或不稳。

最常见的问题涉及手臂外侧的桡侧副韧带复合体。这组韧带可防止前臂骨从上臂骨向外旋转。当该复合体受伤时，您的肘关节可能会以特定的方式发生移位，称为后外侧旋转不稳。这意味着当您尝试撑起身体或接住自己时，骨骼会向后和向外旋转。在这些动作期间，您可能会感到关节外侧有打软感或疼痛。

有时，不稳会影响关节的外侧和内侧。这称为复杂不稳。它涉及多个稳定结构的损伤，包括骨骼本身。在这些情况下，关节失去承受正常负荷的能力。内翻负荷（模拟从椅子上撑起的动作）会导致异常的角度畸形，即使在初始损伤后也会持续存在。这是因为韧带中的正常张力消失了。

您的外科医生将检查您的肘关节，以确定哪些稳定结构受损。由于影像学检查有时无法区分健康的、有弹性的肘关节和真正不稳定的肘关节，因此彻底的体格检查至关重要。我们会寻找不同方向上的特定松动迹象。如果同时存在后外侧和后内侧不稳，我们必须处理这两个区域以恢复完全的稳定。

治疗的目标是修复或重建这些受损的“绳索”。通过收紧或替换韧带，我们帮助您的骨骼重新正确对位。这恢复了关节的自然运动。桡骨头的适当平衡对于正常运动也至关重要。如果没有这种平衡，您的肘关节在日常活动中可能无法顺畅运作。

我们能采取的措施

您主刀医生的治疗策略反映了 Mater Private Hospital Rockhampton 上肢外科医生 Kieran Hirpara 博士在我们诊所对此病的管理方式。我们首先了解您具体的不稳定情况。简单的肘关节脱位通常通过仔细监测和引导性活动即可获得良好疗效。我们使用详细的临床评估和连续 X 线片来追踪您的进展。对于许多患者，保守治疗可带来良好的临床和功能结果。

我们从自我管理和物理治疗开始。您的物理治疗师将设计一个旨在增强肘部周围肌肉力量的方案。这有助于支撑关节并减少关节滑脱的感觉。我们通常建议尝试这种方法一段固定时间，以观察是否能稳定您的症状。对于简单脱位，这种非手术治疗通常已足够。如果您在肘部外侧存在轻微不稳定，特定的锻炼可能有助于您恢复对患肢的信心。

药物治疗侧重于控制疼痛和炎症。我们可能会推荐止痛药或抗炎药，以便您在治疗期间保持舒适。如果疼痛持续存在，我们可能会讨论注射治疗。皮质类固醇注射可在有限时间内减轻肿胀和疼痛。透明质酸或富血小板血浆（PRP）注射也是支持关节健康的选项。这些治疗旨在您的身体愈合或增强力量期间管理症状。它们不能修复结构性撕裂，但可以使活动时的疼痛减轻。

当保守治疗未带来足够改善，或您存在复杂的结构性问题时，会考虑手术治疗。如果您的肘关节向多个方向脱位，我们需要处理两侧以恢复稳定性。我们可能会使用强效缝线或胶带修复撕裂的韧带。在某些情况下，我们使用肌腱移植物重建从肱骨到尺桡骨的韧带。对于迟发性不稳定，重建手术通常能取得相当良好的结果。如果您存在严重僵硬或关节强直，我们可能会使用铰链式外固定架来帮助安全地活动关节。

在复杂病例中，治疗仍然具有挑战性。可能出现持续不稳定、僵硬或疼痛的高发生率。我们会公开讨论这些风险。如果需要关节置换，我们会为存在显著韧带损伤或骨丢失的患者选择连接型关节置换术。当稳定性受损时，这种类型的植入物是首选。我们基于您的 X 线片和检查结果，以共同决策的方式做出此推荐。您的主刀医生将在其专属页面上详细解释手术的具体内容。

预期情况

您的预后主要取决于您的关节不稳是单纯性还是复杂性。单纯的肘关节脱位通常通过仔细监测和非手术治疗即可获得良好恢复。大多数患者的症状会消退，并恢复接近完全的肘关节屈曲和前臂旋转活动范围。如果您的病例更为复杂，涉及严重的韧带或骨骼损伤，则治疗过程更具挑战性。此类病例的治疗仍然困难，出现持续性不稳、僵硬、疼痛和创伤后关节炎（磨损性关节炎）的概率较高。

对于复杂性损伤，通常需要进行手术以恢复稳定性。韧带修复和重建通常能提供可接受的功能结果。您可以期望恢复稳定性，尽管复杂性手术管理的长期结果尚未完全明确。在极具挑战性的病例中，部分患者可能会出现持续问题。如果您接受了全肘关节置换术，不稳是一个主要风险，可能需要进一步手术。当韧带受损时，通常首选连接式假体置换以降低此风险。

恢复是一个渐进的过程。您需要详细的临床评估和定期 X 线检查以追踪愈合情况。即使治疗成功，肘关节由静态和动态稳定结构组成，这些结构必须协同工作。这些结构完全愈合需要时间。部分患者在术后两年报告主观满意度高且结果良好，但其他患者可能面临长期挑战。您的外科医生将指导您度过这一过程，确保满足您的特定需求。我们旨在提供清晰、诚实的信息，让您对恢复过程中的现实预期有充分了解。

何时就医

若肘部疼痛持续且休息后无改善，请咨询全科医生。若感到无力、关节不稳，或关节出现卡顿/脱位，请要求专科医生评估。这些症状可能干扰您的睡眠或工作。受伤后症状突然加重也需引起重视。复杂的肘关节不稳涉及重要的骨性与韧带稳定结构。简单的脱位需要详细的临床评估及系列影像学随访。超声检查无法客观区分正常肘关节与过度活动肘关节。完整的病史采集与体格检查对于准确诊断至关重要。早期评估有助于预防僵硬或创伤后关节炎等长期并发症。

Reviewed by Dr Kieran Hirpara · 7 August 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Complex elbow instability requires balancing stability, mobility, and concentric reduction [1].
  • Further research, particularly multicenter prospective trials, is needed for complex elbow instability due to the rare nature of these injuries [1].
  • Elbow instability in children involves nontraumatic causes as well as traumatic injuries [2].
  • Elbow arthroscopy is a valid and safe option for diagnosing and treating acute elbow instability [3].
  • Elbow arthroscopy is a valid and safe option for diagnosing and treating chronic elbow instability [3].
  • Elbow arthroscopy allows management of soft tissue lesions in elbow instability with minimal disruption [3].
  • Elbow arthroscopy allows management of associated intra-articular bone or cartilage lesions in elbow instability with minimal disruption [3].
  • Elbow arthroscopy is a valuable tool for diagnosing chronic elbow instability [6].
  • Elbow arthroscopy is a valuable tool for managing chronic elbow instability [6].
  • Elbow instability injuries are an infrequent source of disability for select NCAA athletes [4].
  • Elbow instability injuries are a serious source of disability for select NCAA athletes [4].
  • There are associated risk factors for elbow instability injuries in NCAA athletes [4].
  • Good long-term outcomes are reported after non-operative management of simple elbow dislocations [8].
  • Approximately 2% of patients require surgical intervention if simple elbow dislocations are treated nonoperatively [8].
  • Approximately 8% of patients develop persistent instability symptoms if simple elbow dislocations are treated nonoperatively [8].
  • A standard surgical protocol for treating elbow dislocations with radial head and coronoid fractures restores sufficient stability to allow early motion postoperatively [17].
  • Early motion postoperatively enhances functional outcome in elbow dislocations with radial head and coronoid fractures treated with a standard surgical protocol [17].
  • Operative repair is indicated for most fracture-dislocations of the elbow to restore sufficient osseoligamentous support [20].
  • Restoring sufficient osseoligamentous support allows safe, early motion in elbow fracture-dislocations [20].
  • Restoring sufficient osseoligamentous support provides a stable functional elbow in the long term for elbow fracture-dislocations [20].
  • Current evidence regarding the optimal elbow flexion angle for graft fixation in ulnar collateral ligament reconstruction possesses a high degree of fragility [25].
  • Further studies with objective measurements are needed to determine the optimal elbow flexion angle for graft fixation in ulnar collateral ligament reconstruction [25].
  • Surgery is indicated for unstable elbows requiring flexion beyond 50 to 60 degrees to remain reduced [27].
  • Surgery is indicated for unstable periarticular fractures [27].
  • Instability is the major complication of unlinked total elbow arthroplasty [30].
  • Instability after unlinked total elbow arthroplasty often requires revision [30].
  • Linked arthroplasty is preferred for patients with posttraumatic articular damage [30].
  • Linked arthroplasty is preferred for patients with ligamentous instability [30].
  • Linked arthroplasty is preferred for patients with deformity [30].
  • Linked arthroplasty is preferred for patients with bone loss [30].

Anatomy & Pathophysiology

  • The elbow consists of static and dynamic stabilizers that function in synchrony to prevent elbow instability [18].
  • Simple dislocations of the elbow are highly congruent joints with inherent stability provided by bony structures and dynamic stabilizers [28].
  • Understanding elbow biomechanics and the injury mechanism provides valuable insight into the variations of pathology that may be observed [21].
  • Recognising the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain and weakness [9].
  • An understanding of the relevant anatomy and the factors associated with elbow stability allows for the application of a systematic algorithm for treatment [12].
  • Optimal outcomes are founded upon concentric reduction of the elbow [19].
  • The primary goal of treatment is stable reduction of the ulnohumeral joint and functional elbow motion [15].
  • A stiff, congruent elbow is preferable to an unstable elbow [36].
  • PLRI of the elbow remains to be fully understood [34].

Classification

  • Complex elbow instability is a distinct clinical entity requiring a balance between stability, mobility, and concentric reduction [1].
  • Complex elbow instability is rare, necessitating multicenter prospective trials for further research [1].
  • Elbow instability in children includes nontraumatic causes in addition to traumatic injuries [2].
  • The Wrightington classification of traumatic elbow instability is a comprehensive, reliable, and valid classification system [32].
  • The Wrightington classification is associated with treatment algorithms that lead to good functional outcomes [32].
  • Understanding the precise pattern of injury is critical for restoring elbow function and preventing chronic instability, pain, and weakness [9].
  • Elbow instability injuries are an infrequent but serious source of disability for select NCAA athletes [4].
  • Elbow instability injuries in NCAA athletes have associated risk factors [4].
  • The elbow consists of static and dynamic stabilizers that function in synchrony to prevent instability [18].
  • Understanding elbow biomechanics and injury mechanisms provides insight into variations of pathology in traumatic elbow instability [21].
  • Understanding patterns of traumatic elbow instability helps surgeons counsel and manage patients [7].
  • An algorithmic approach to diagnosis and treatment of complex elbow fracture-dislocations can improve diagnostic assessment and reconstruction of bony and ligamentous restraints [29].
  • A systematic algorithm for treatment of terrible triad injuries, based on anatomy and stability factors, ensures sufficient stability for early motion and improved outcomes [12].
  • A treatment algorithm for elbow dislocations, ranging from soft tissue injuries to complex fracture-dislocations, is based on clinical evidence and addresses basic scientific aspects of treating elbow stiffness [22].

Clinical Presentation

  • Complex elbow instability is a challenging clinical entity requiring a balance between stability, mobility, and concentric reduction [1].
  • Elbow instability in children includes nontraumatic causes [2].
  • Elbow arthroscopy is a valid and safe option for the diagnosis of acute elbow instability [3].
  • Elbow arthroscopy is a valid and safe option for the diagnosis of chronic elbow instability [3].
  • Elbow arthroscopy is a valid and safe option for the treatment of acute elbow instability [3].
  • Elbow arthroscopy is a valid and safe option for the treatment of chronic elbow instability [3].
  • A simple elbow dislocation that is rotationally unstable can be stabilized by simply repositioning the forearm [5].
  • Understanding the patterns of traumatic elbow instability helps the surgeon counsel and manage patients with these injuries [7].
  • Good long-term outcomes have been reported after non-operative management of simple elbow dislocations [8].
  • A small proportion (2%) of patients require surgical intervention if simple elbow dislocations are treated nonoperatively [8].
  • All patients in the series of lateral collateral ligament instability had resolution of their symptoms of instability [10].
  • Patients with lateral collateral ligament instability regained a near full arc of elbow flexion and forearm rotation [10].
  • Fixation or replacement of injured bony elements, ligamentous repair, and hinged fixation may be used to successfully manage complex elbow instability [11].
  • An understanding of the relevant anatomy and factors associated with elbow stability allows the application of a systematic algorithm for treatment of terrible triad injuries [12].
  • The systematic algorithm for terrible triad injury treatment helps ensure sufficient elbow stability to allow early motion [12].
  • Early motion in terrible triad injury leads to improved outcomes in most patients [12].
  • The next challenge for elbow surgeons is to diagnose and fix persistent subclinical instability after surgery to prevent the onset of post-traumatic osteoarthritis [13].
  • Simple elbow dislocations are usually managed by closed reduction and early motion [16].
  • Recurrent instability is uncommon in simple elbow dislocations due to intrinsic bony stability [16].
  • Posterolateral rotatory instability of the elbow is a clinical syndrome caused by insufficiency of the lateral ulnar collateral ligament [23].
  • Posterolateral rotatory instability of the elbow presents with clicking, locking, or recurrent dislocation [23].
  • Most simple elbow dislocations are readily managed nonoperatively [24].
  • Most simple elbow dislocations are amenable to early mobilization [24].
  • The variability in patients' pathoanatomic conditions in chronic complex persistent elbow instability requires customized surgical treatment [31].
  • Surgical treatment for chronic complex persistent elbow instability is aimed at elbow stabilizer reconstruction when the ulnohumeral joint is preserved [31].
  • Surgical treatment for chronic complex persistent elbow instability is aimed at joint replacement in case of severe articular degeneration [31].

Investigations

  • Complex elbow instability requires recognition of the precise injury pattern to restore function and prevent chronic instability, pain, and weakness [9].
  • Elbow instability injuries are an infrequent but serious source of disability for select National Collegiate Athletic Association (NCAA) athletes [4].
  • Proximal radioulnar translocation with radial neck fracture and elbow dislocation is an extremely rare injury in children that requires careful radiographic evaluation to avoid delayed diagnosis [46].
  • Concomitant vascular lesions, such as brachial artery transection, must be considered when confronted with elbow dislocations [44].
  • Elbow arthroscopy is a valid and safe option for the diagnosis of both acute and chronic elbow instability [3].
  • Elbow arthroscopy is a valuable tool in the diagnosis of chronic elbow instability [6].
  • Nontraumatic causes of elbow instability in children are addressed in current concepts of pediatric elbow injuries [2].

Treatment

Non-Operative Management

  • Most simple elbow dislocations are readily managed nonoperatively and are amenable to early mobilization [24].
  • Conservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation [43].
  • Simple elbow dislocations should be managed with early range of motion, as most do not require surgery [42].
  • Rehabilitation programs for simple elbow dislocations should stress early active range of motion through the stable arc of motion [5].

Operative Management

  • Operative repair is indicated for most fracture-dislocations of the elbow to restore sufficient osseoligamentous support to allow safe, early motion and provide a stable functional elbow in the long term [20].
  • Surgery is indicated for unstable elbows requiring flexion beyond 50 to 60 degrees to remain reduced or for unstable periarticular fractures [27].
  • Elbow valgus instability in the throwing athlete may be managed either nonsurgically or surgically [39].
  • Use of a standard surgical protocol for elbow dislocations with radial head and coronoid fractures restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome [17].
  • Both Jobe and Docking techniques are safe and effective in the treatment of posterolateral elbow instability [26].

Arthroscopic Management

  • Elbow arthroscopy has become a valid and safe option for the diagnosis and treatment of both acute and chronic elbow instability, allowing for the management of soft tissue lesions and associated intra-articular bone or cartilage lesions with minimal disruption [3].
  • Elbow arthroscopy is a valuable tool in the diagnosis and management of chronic elbow instability [6].
  • Elbow arthroscopy is not necessarily contraindicated in patients with a subluxating or transposed ulnar nerve [35].

Surgical Goals and Outcomes

  • The primary goal of treatment for nonacute elbow fracture with persistent ulnohumeral dislocation or subluxation is stable reduction of the ulnohumeral joint and functional elbow motion [15].
  • Optimal outcomes for traumatic elbow instability are founded upon concentric reduction of the elbow [19].
  • Complex elbow instability requires a balance between stability, mobility, and concentric reduction [1].
  • Despite progress in surgical techniques and rehabilitation, treatments for elbow instability remain challenging with high rates of persistent instability, post-traumatic arthritis, stiffness, and pain in demanding cases [33].
  • Few patients with simple elbow dislocations develop complications requiring surgery [14].
  • Patients with simple elbow dislocations who require surgery most commonly undergo soft-tissue stabilisation or contracture release within 4 years of the injury [14].
  • A small proportion (2%) of patients require surgical intervention for simple elbow dislocations [8].

Complications

  • Approximately 8% of patients treated nonoperatively for simple elbow dislocation develop persistent instability symptoms [8].
  • A small proportion (2%) of patients with simple elbow dislocation require surgical intervention [8].
  • Persistent subclinical instability after surgery can lead to the onset of post-traumatic osteoarthritis [13].
  • Patients with simple elbow dislocations who develop complications most commonly undergo soft-tissue stabilisation or contracture release within 4 years of the injury [14].
  • Instability is the major complication of unlinked total elbow arthroplasty, often requiring revision [30].
  • Linked arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss [30].
  • Ulnar collateral ligament reconstruction (UCLR) demonstrates low complication and revision rates at minimum 48-month mean follow-up [38].
  • There is a distinct difference in complication profile between external fixation and the IJS when used as treatment for traumatic elbow instability [40].

Recovery

  • Rehabilitation programs for rotationally unstable simple elbow dislocations should stress early active range of motion through the stable arc of motion [5].
  • Non-operative management of simple elbow dislocations yields good long-term outcomes [8].
  • Approximately 2% of patients treated nonoperatively for simple elbow dislocation require surgical intervention [8].
  • Recognizing the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain, and weakness [9].
  • Diagnosing and fixing persistent subclinical instability after surgery is necessary to prevent the onset of post-traumatic osteoarthritis [13].
  • Patients with simple elbow dislocations who require subsequent surgery most commonly undergo soft-tissue stabilization or contracture release within 4 years of the injury [14].
  • Recurrent instability is uncommon after simple elbow dislocation due to intrinsic bony stability [16].
  • Use of a standard surgical protocol for elbow dislocations with radial head and coronoid fractures restores sufficient elbow stability to allow early motion postoperatively [17].
  • Early motion postoperatively enhances functional outcome in the treatment of elbow dislocations with radial head and coronoid fractures [17].
  • Athletes with elbow dislocation demonstrate excellent functional outcomes and high return to sport rates [41].
  • Most athletes with elbow dislocation return to sport within 10 weeks [41].
  • The prognosis for simple elbow dislocations is better than for complex dislocations [47].
  • Prolonged immobilization is associated with unsatisfactory results in elbow dislocations [47].

Key Evidence

  • [L5] Complex elbow instability remains a challenging clinical entity requiring a balance between stability, mobility, and concentric reduction; further research, particularly multicenter prospective trials, is needed due to the rare nature of these injuries. [1] (10.1016/j.hcl.2007.11.010)
  • [L5] The article reviews current concepts of injuries leading to elbow instability in children, discusses recognition and treatment of instability, and addresses nontraumatic causes. [2] (10.1016/j.hcl.2007.11.007)
  • [L5] Elbow arthroscopy has become a valid and safe option for the diagnosis and treatment of both acute and chronic elbow instability, allowing for the management of soft tissue lesions and associated intra-articular bone or cartilage lesions with minimal disruption. [3] (10.1016/j.jseint.2022.12.001)
  • [L4] Elbow instability injuries are an infrequent but serious source of disability for select NCAA athletes, with a number of associated risk factors. [4] (10.1177/2325967117750105)
  • [L5] A simple elbow dislocation that is rotationally unstable can be stabilized by simply repositioning the forearm, and rehabilitation programs should stress early active range of motion through the stable arc of motion. [5] (10.1016/j.hcl.2015.06.002)
  • [L4] Elbow arthroscopy is a valuable tool in the diagnosis and management of chronic elbow instability. [6] (10.1016/j.arthro.2013.08.016)
  • [L5] Understanding the patterns of traumatic elbow instability helps the surgeon counsel and manage patients with these injuries. [7] (10.1016/j.jhsa.2010.05.002)
  • [L5] Good long-term outcomes have been reported after non-operative management of simple elbow dislocations; however, a small proportion (2%) of patients require surgical intervention and approximately 8% develop persistent instability symptoms if treated nonoperatively. [8] (10.1177/1758573217694163)
  • [Paper] Recognising the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain and weakness. [9] (10.1016/j.injury.2013.09.032)
  • [L4] All patients in the series had resolution of their symptoms of instability and regained a near full arc of elbow flexion and forearm rotation. [10] (10.1016/j.hcl.2007.11.001)
  • [L5] Fixation or replacement of injured bony elements, ligamentous repair, and hinged fixation may be used to successfully manage complex elbow instability. [11] (10.5435/00124635-200605000-00003)
  • [L5] Despite the complexities of this injury, an understanding of the relevant anatomy and the factors associated with elbow stability allows the application of a systematic algorithm for treatment that can help ensure sufficient elbow stability to allow early motion, thereby leading to improved outcomes in most patients. [12] (10.5435/00124635-200903000-00003)
  • [L5] The next challenge for elbow surgeons is to diagnose and fix persistent subclinical instability after surgery to prevent the onset of post-traumatic osteoarthritis. [13] (10.1016/j.jseint.2023.03.018)
  • [Paper] Few patients with simple elbow dislocations develop complications requiring surgery, but those that do most commonly undergo soft-tissue stabilisation or contracture release within 4 years of the injury. [14] (10.1016/j.injury.2015.02.009)
  • [L5] The primary goal of treatment is stable reduction of the ulnohumeral joint and functional elbow motion. [15] (10.2106/jbjs.m.00817)
  • [L5] Simple elbow dislocations are usually managed by closed reduction and early motion, with recurrent instability being uncommon due to intrinsic bony stability. [16] (10.1016/j.hcl.2007.11.012)
  • [L4] Use of the surgical protocol restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome. [17] (10.2106/jbjs.d.02933)
  • [L5] The elbow consists of static and dynamic stabilizers that function in synchrony to prevent elbow instability. [18] (10.1016/j.jhsa.2016.11.025)
  • [L5] Optimal outcomes are founded upon concentric reduction of the elbow. [19] (10.1016/j.jseint.2023.03.020)
  • [L5] Operative repair is indicated for most of these injuries to restore sufficient osseoligamentous support to allow safe, early motion and provide a stable functional elbow in the long term. [20] (10.1016/j.hcl.2004.06.005)
  • [L4] Understanding elbow biomechanics and the injury mechanism provides valuable insight into the variations of pathology that may be observed. [21] (10.5435/jaaos-d-14-00023)
  • [L5] The authors present a treatment algorithm based on their clinical evidence and discuss new basic scientific aspects of treating elbow stiffness. [22] (10.1155/2013/951397)
  • [L5] Posterolateral rotatory instability of the elbow is a clinical syndrome caused by insufficiency of the lateral ulnar collateral ligament, presenting with clicking, locking, or recurrent dislocation. [23] (10.5435/00124635-200411000-00005)
  • [L5] Most simple elbow dislocations are readily managed nonoperatively and are amenable to early mobilization. [24] (10.1016/j.hcl.2020.07.013)
  • [L4] However, the available current evidence possesses a high degree of fragility, and further studies are needed with objective measurements to determine the optimal elbow flexion angle for graft fixation. [25] (10.1016/j.jse.2018.07.029)
  • [L1] This systematic review showed that both Jobe and Docking techniques are safe and effective in the treatment of posterolateral elbow instability. [26] (10.1016/j.injury.2020.11.010)
  • [L5] Surgery is indicated for unstable elbows requiring flexion beyond 50 to 60 degrees to remain reduced or for unstable periarticular fractures. [27] (10.5435/00124635-199801000-00002)
  • [L5] Simple dislocations of the elbow are highly congruent joints with inherent stability provided by bony structures and dynamic stabilizers, allowing for early active range of motion during rehabilitation. [28] (10.1016/j.hcl.2004.07.002)
  • [L5] An algorithmic approach to the diagnosis and treatment of complex elbow fracture-dislocation injuries can improve the diagnostic assessment and reconstruction of the bony and ligamentous restraints to restore a stable and functional elbow. [29] (10.5435/jaaos-d-23-00460)
  • [L4] Instability is the major complication of unlinked total elbow arthroplasty, often requiring revision, whereas linked arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss. [30] (10.1016/j.hcl.2007.11.002)
  • [L4] The variability in patients' pathoanatomic conditions requires customized surgical treatment aimed at elbow stabilizer reconstruction when the ulnohumeral joint is preserved or aimed at joint replacement in case of severe articular degeneration. [31] (10.1016/j.jse.2019.11.021)
  • [L5] The Wrightington classification of elbow fracture dislocation is a comprehensive, reliable, and valid classification with treatment algorithms that are associated with good functional outcomes. [32] (10.1016/j.jseint.2022.12.002)
  • [L5] Despite progress in surgical techniques and rehabilitation, treatments for elbow instability remain challenging with high rates of persistent instability, post-traumatic arthritis, stiffness, and pain in demanding cases. [33] (10.1136/jisakos-2019-000316)
  • [L4] PLRI of the elbow remains to be fully understood. [34] (10.1016/j.arthro.2014.02.029)
  • [L4] Elbow arthroscopy is not necessarily contraindicated in patients with a subluxating or transposed ulnar nerve. [35] (10.1016/j.arthro.2009.04.024)
  • [L5] A stiff, congruent elbow is preferable to an unstable elbow. [36] (10.1016/j.hcl.2017.09.008)
  • [L4] UCLR provides excellent patient-reported and clinical outcomes to patients at medium-term follow-up with low complication and revision rates. [38] (10.1136/jisakos-2021-000614)
  • [L5] Elbow valgus instability in the throwing athlete may be managed either nonsurgically or surgically. [39] (10.5435/00124635-200611000-00014)
  • [L4] The literature demonstrates a distinct difference in complication profile between external fixation and the IJS when used as treatment for traumatic elbow instability. [40] (10.1016/j.xrrt.2023.12.004)
  • [L4] Athletes with elbow dislocation demonstrated excellent functional outcomes and high return to sport rates, with most returning within 10 weeks. [41] (10.1177/23259671261419505)
  • [L5] Simple elbow dislocations should be managed with early range of motion, as most do not require surgery. [42] (10.1016/j.hcl.2016.08.003)
  • [L1] Conservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation. [43] (10.1186/s12891-024-07260-0)
  • [Case_report] This case should sensitize the readers for concomitant vascular lesions when confronted with elbow dislocations. [44] (10.1007/s00167-010-1202-5)
  • [Case_report] Proximal radioulnar translocation with radial neck fracture and elbow dislocation is an extremely rare injury in children that requires careful radiographic evaluation to avoid delayed diagnosis. [46] (10.1007/s00402-013-1820-8)
  • [L5] The prognosis for simple dislocations is better than for complex dislocations, and prolonged immobilization is associated with unsatisfactory results. [47] (10.1016/j.csm.2004.04.014)

References

[1] Complex Elbow Instability. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2007.11.010

[2] Elbow Instability in Children. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2007.11.007

[3] The role of arthroscopy in instability of the elbow. JSES International. 2023. DOI: 10.1016/j.jseint.2022.12.001

[4] Elbow Dislocation and Subluxation Injuries in the National Collegiate Athletic Association, 2009-2010 Through 2013-2014. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967117750105

[5] Simple Elbow Dislocation. Hand Clinics. 2015. DOI: 10.1016/j.hcl.2015.06.002

[6] The Role of Arthroscopy in Chronic Elbow Instability. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.08.016

[7] Traumatic Elbow Instability. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.05.002

[8] Simple elbow dislocation. Shoulder & Elbow. 2017. DOI: 10.1177/1758573217694163

[9] Complex instability of the elbow. Injury. 2017. DOI: 10.1016/j.injury.2013.09.032

[10] Lateral Collateral Ligament Instability of the Elbow. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2007.11.001

[11] Complex Elbow Instability. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200605000-00003

[12] Terrible Triad Injury of the Elbow: Current Concepts. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200903000-00003

[13] Terrible triad injury of the elbow: a spectrum of theories. JSES International. 2023. DOI: 10.1016/j.jseint.2023.03.018

[14] The frequency and risk factors for subsequent surgery after a simple elbow dislocation. Injury. 2015. DOI: 10.1016/j.injury.2015.02.009

[15] Nonacute Treatment of Elbow Fracture with Persistent Ulnohumeral Dislocation or Subluxation. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.00817

[16] Acute Dislocations of the Adult Elbow. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2007.11.012

[17] Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.d.02933

[18] Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2016.11.025

[19] Coronoid fractures and traumatic elbow instability. JSES International. 2023. DOI: 10.1016/j.jseint.2023.03.020

[20] Fracture-dislocation of the elbow: diagnosis, treatment, and prognosis. Hand Clinics. 2004. DOI: 10.1016/j.hcl.2004.06.005

[21] Management of Complex Elbow Dislocations. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00023

[22] Elbow Dislocations: A Review Ranging from Soft Tissue Injuries to Complex Elbow Fracture Dislocations. Advances in Orthopedics. 2013. DOI: 10.1155/2013/951397

[23] Posterolateral Rotatory Instability of the Elbow. Journal of the American Academy of Orthopaedic Surgeons. 2004. DOI: 10.5435/00124635-200411000-00005

[24] Elbow Instability. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.07.013

[25] Elbow flexion angle during graft fixation for ulnar collateral ligament reconstruction: a systematic review of outcomes and complications. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2018.07.029

[26] Lateral collateral ulnar ligament reconstruction techniques in posterolateral rotatory instability of the elbow: A systematic review. Injury. 2022. DOI: 10.1016/j.injury.2020.11.010

[27] Acute Elbow Dislocation: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199801000-00002

[28] Simple dislocations of the elbow: evaluation and treatment. Hand Clinics. 2004. DOI: 10.1016/j.hcl.2004.07.002

[29] Complex Elbow Fracture-Dislocations: An Algorithmic Approach to Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2024. DOI: 10.5435/jaaos-d-23-00460

[30] Instability After Total Elbow Arthroplasty. Hand Clinics. 2008. DOI: 10.1016/j.hcl.2007.11.002

[31] Chronic complex persistent elbow instability: a consecutive and prospective case series and review of recent literature. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.11.021

[32] “How the Wrightington classification of traumatic elbow instability can simplify the algorithm for treatment”. JSES International. 2023. DOI: 10.1016/j.jseint.2022.12.002

[33] Treatment of elbow instability: state of the art. Journal of ISAKOS. 2021. DOI: 10.1136/jisakos-2019-000316

[34] Surgical Treatment of Posterolateral Rotatory Instability of the Elbow. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.02.029

[35] Is Elbow Arthroscopy Safe in Patients with a Subluxating ulnar nerve or Previous Ulnar Nerve Transposition? (SS‐24). Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.024

[36] Elbow Fractures with Instability. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.09.008

[38] Ulnar collateral ligament reconstruction of the elbow at minimum 48-month mean follow-up demonstrates excellent clinical outcomes with low complication and revision rates: systematic review. Journal of ISAKOS. 2021. DOI: 10.1136/jisakos-2021-000614

[39] Elbow Valgus Instability in the Throwing Athlete. Journal of the American Academy of Orthopaedic Surgeons. 2006. DOI: 10.5435/00124635-200611000-00014

[40] Comparing internal and external stabilization for traumatic elbow instability: a systematic review. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2023.12.004

[41] Return to Sport Following Elbow Dislocation: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261419505

[42] Elbow Dislocations in Contact Sports. Hand Clinics. 2017. DOI: 10.1016/j.hcl.2016.08.003

[43] Treatment strategies for simple elbow dislocation - a systematic review. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07260-0

[44] Brachial artery transection caused by closed elbow dislocation in a mature in‐line skater: a case report with review of the literature. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1202-5

[46] Proximal radioulnar translocation associated with elbow dislocation and radial neck fracture in child: a case report and review of literature. Archives of Orthopaedic and Trauma Surgery. 2013. DOI: 10.1007/s00402-013-1820-8

[47] Elbow dislocations in adults and children. Clinics in Sports Medicine. 2004. DOI: 10.1016/j.csm.2004.04.014

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