Chronic Elbow Dislocation: Evaluation and Management.

Chronic elbow dislocation is defined as a dislocation that has remained unreduced for >2 weeks. The soft-tissue and skeletal changes that develop during this time usually prevent successful closed reduction. These changes include the development of extensive intra-articular fibrotic tissue, as well as contracture of the triceps, collateral ligaments, and elbow capsule. Ulnar nerve involvement and associated fractures may also be present. Because treatment of chronic elbow dislocation is challenging, a stepwise approach is used in the evaluation and management of this condition. No large series of data are available to guide treatment. Most patients are treated on the basis of the surgeon's anecdotal experience. Treatment typically involves open reduction, often with the use of hinged external fixators. The role of triceps lengthening or primary collateral ligament reconstruction remains a topic of debate.