Obtain history that includes the mechanism of injury, type and location of pain, amount of immediate dysfunction, treatment prior to arrival in the emergency department, timing of effusion appearance, and history of prior elbow injury. Elbow is flexed, with an exaggerated prominence of the olecranon. The elbow is held in full extension. The upper arm appears shortened while the forearm is elongated and held in supination. Neurovascular function should be documented in detail before and after reduction.
Continued reexamination is essential.
Radiography Plain radiographs are essential prior to reduction of the suspected dislocation. Postreduction films should confirm opposition of the joint surfaces and should rule out previously unidentified fractures or entrapment of bony fragments within the joint space. Prehospital personnel should splint the limb in the position found. Because of the risk of neurovascular injury, field reduction is not indicated. Successful reduction is unlikely without adequate analgesia and sedation.