This review organizes elbow instability into a spectrum: acute dislocation, chronic unreduced dislocation, and recurrent instability. It walks through diagnosis and management for each pattern, emphasizing the most common entities. The framework rests on how the articular surface and ligaments each contribute to stability.
The clinical anchor here: a simple elbow dislocation is a soft-tissue injury that heals reliably, so reduce it and start moving it early. The randomized data show surgery for the uncomplicated dislocation produces worse contractures and worse patient-rated outcomes. Prolonged immobilization, not the injury itself, drives residual pain and stiffness.
The decision changes when a fracture is present. An associated coronoid or radial head fracture converts a benign injury into a stability problem involving both bone and ligament, and outcomes worsen with fracture severity. Remember the radial head's role: expendable when the MCL is intact, but a critical secondary stabilizer once the MCL is deficient.
For recurrent instability, think lateral ulnar collateral ligament deficiency and posterolateral rotatory instability first. And counsel patients that the best chance for a good MCL or LCL reconstruction is the first one, before scarring or a failed prior procedure.
This review organizes elbow instability into a spectrum: acute dislocation, chronic unreduced dislocation, and recurrent instability. It walks through diagnosis and management for each pattern, emphasizing the most common entities. The framework rests on how the articular surface and ligaments each contribute to stability.
The clinical anchor here: a simple elbow dislocation is a soft-tissue injury that heals reliably, so reduce it and start moving it early. The randomized data show surgery for the uncomplicated dislocation produces worse contractures and worse patient-rated outcomes. Prolonged immobilization, not the injury itself, drives residual pain and stiffness.
The decision changes when a fracture is present. An associated coronoid or radial head fracture converts a benign injury into a stability problem involving both bone and ligament, and outcomes worsen with fracture severity. Remember the radial head's role: expendable when the MCL is intact, but a critical secondary stabilizer once the MCL is deficient.
For recurrent instability, think lateral ulnar collateral ligament deficiency and posterolateral rotatory instability first. And counsel patients that the best chance for a good MCL or LCL reconstruction is the first one, before scarring or a failed prior procedure.