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The Journal of Bone and Joint Surgery (American) 82:724 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.

Instructional Course Lecture

The Unstable Elbow*{dagger}

Shawn W. O'Driscoll, Ph.D., M.D., F.R.C.S.(c){ddagger}, Jesse B. Jupiter, M.D.§, Graham J. W. King, M.D, M.Sc., F.R.C.S.(C)#, Robert N. Hotchkiss, M.D.** and Bernard F. Morrey, M.D.{ddagger}

An Instructional Course Lecture, American Academy of Orthopaedic Surgeons
*Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in March 2001 in Instructional Course Lectures, Volume 50. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 A.M.-5 P.M., Central time).
{dagger}One or more of the authors has received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this article. No funds were received in support of this article.
{ddagger}Mayo Clinic, 200 First Street S.W., Rochester, Minnesota 55905.
§Department of Orthopaedic Surgery, Massachusetts General Hospital, WACC 527, 15 Parkman Street, Boston, Massachusetts 02114.
#Hand and Upper Limb Centre, St. Joseph's Health Centre, 168 Grosvenor Street, London, Ontario N6A 4V2, Canada.
**The Hospital for Special Surgery, 535 East 70th Street, New York, N.Y. 10021.

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   Biomechanics of Elbow Dislocation
 
Pathoanatomy
The pathoanatomy of an elbow dislocation can be thought of as a disruption of the circle of soft tissue or bone, or both, that begins on the lateral side of the elbow and progresses to the medial side in three stages (Fig. 1-A). In stage 1, the lateral collateral ligament is partially or completely disrupted (the ulnar part is disrupted). This disruption results in posterolateral rotatory subluxation of the elbow, which can reduce spontaneously (Fig. 1-B). Stage 2 involves additional disruption anteriorly and posteriorly. There is an incomplete posterolateral dislocation of the elbow in which the concave medial edge of the ulna rests on the trochlea. On a lateral radiograph of the elbow, the coronoid process appears to be perched on the trochlea. This dislocation can be reduced with use of minimal force or by the patient manipulating his or her own elbow. Stage 3 is . . . [Full Text of this Article]


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