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Elbow Instability

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

47 citationsUpdated Aug 2026

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Overview

Complex elbow instability requires balancing stability, mobility, and concentric reduction [1]. Elbow arthroscopy serves as a valid and safe diagnostic and therapeutic option for both acute and chronic instability, allowing management of soft tissue and associated intra-articular bone or cartilage lesions with minimal disruption [3]. It remains a valuable tool specifically for the diagnosis and management of chronic elbow instability [5]. However, further research, particularly multicenter prospective trials, is needed due to the rare nature of these injuries [1].

Simple elbow dislocations treated nonoperatively yield good long-term outcomes, with approximately 2% of patients requiring surgical intervention and 8% developing persistent instability symptoms [7]. In contrast, operative repair is indicated for most fracture-dislocations to restore sufficient osseoligamentous support, allowing safe, early motion and providing a stable functional elbow in the long term [21]. The standard surgical protocol for dislocations with radial head and coronoid fractures restores sufficient stability for early motion and enhances functional outcome [17]. Surgery is also indicated for unstable elbows requiring flexion beyond 50 to 60 degrees to remain reduced and for unstable periarticular fractures [28].

For contact sports athletes, surgical management is indicated when the elbow remains unstable after dislocation, with the lateral ulnar collateral ligament identified as the most critical structure to repair or reconstruct [32]. Elbow instability injuries represent a serious source of disability for select NCAA athletes, though they are an infrequent source of disability overall, with multiple associated risk factors existing [9]. In the context of total elbow arthroplasty, instability is the major complication of unlinked implants and often requires revision [31]. Linked arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss [31]. Current evidence regarding the optimal elbow flexion angle for graft fixation in ulnar collateral ligament reconstruction possesses a high degree of fragility, necessitating further studies with objective measurements [26].

Anatomy & Pathophysiology

The elbow relies on static and dynamic stabilizers that function in synchrony to prevent instability [18]. Simple dislocations involve highly congruent joints where inherent stability is provided by bony structures and dynamic stabilizers [29]. Understanding elbow biomechanics and the injury mechanism provides valuable insight into the variations of pathology that may be observed [22]. Recognising the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain, and weakness [8]. An understanding of the relevant anatomy and the factors associated with elbow stability allows for the application of a systematic algorithm for treatment [13]. Posterolateral rotatory instability (PLRI) of the elbow remains to be fully understood [38].

Classification

Elbow dislocations are the second most common medium to large joint dislocation of the upper extremity after the glenohumeral joint [47]. The incidence is 5.2 cases per 100,000 person-years [47]. Approximately one-quarter of all elbow dislocations involve a fracture [47].

Simple vs. Complex: Acute elbow dislocations without associated fractures are simple dislocations [33]. Dislocations associated with fractures are complex dislocations [33]. Complex elbow instability requires balancing stability, mobility, and concentric reduction [1].

Directional Subclassification: Subclassification is based on the direction of displacement of the radius and ulna relative to the distal humerus [33]. Types include posterior, lateral, anterior, and divergent dislocations [33]. Posterior dislocation is the most common type [33]. There is little value in distinguishing between posterior, posterolateral, and posteromedial dislocations because this is often difficult to determine and hardly influences management [33]. Dislocations involving disruption of the proximal radioulnar joint are divergent dislocations, which are rare [33]. Anterior dislocations involve either an olecranon fracture or triceps disruption, usually requiring surgical correction [33].

Morrey Classification: Categorizes elbow instability into simple and complex instability [19].

Horii Circle: Classifies simple acute elbow instability as a spectrum of instability including subluxation and dislocation [19].

Complex Subtypes: Complex elbow instability subtypes include terrible triad, trans-olecranon fracture-dislocation, and antero-medial coronoid fracture [19]. The three main patterns of instability in elbow fracture-dislocation are valgus posterolateral rotatory instability, varus posteromedial rotatory instability, and transolecranon fracture-dislocation [47].

Wrightington Classification: This is a comprehensive, reliable, and valid classification of elbow fracture dislocation with associated treatment algorithms that lead to good functional outcomes [37].

SICSGeG Instability Classification: This is an all-inclusive classification system for elbow instability [19].

Other Considerations: Understanding the patterns of traumatic elbow instability helps surgeons counsel and manage patients [6]. Understanding elbow biomechanics and injury mechanism provides insight into variations of pathology in complex elbow dislocations [22]. A treatment algorithm for elbow dislocations ranges from soft tissue injuries to complex elbow fracture dislocations [23]. An algorithmic approach to diagnosis and treatment of complex elbow fracture-dislocation injuries can improve diagnostic assessment and reconstruction of bony and ligamentous restraints [30]. Elbow arthroscopy is a valid and safe option for the diagnosis and treatment of both acute and chronic elbow instability [3]. It is also a valuable tool in the diagnosis and management of chronic elbow instability [5]. Validated outcome measures for elbow instability include the Mayo Elbow Performance Score and the DASH Score [19].

Clinical Presentation

Complex elbow instability presents as a challenging clinical entity requiring a delicate balance between stability, mobility, and concentric reduction [1]. In children, elbow instability may include nontraumatic causes [2]. Understanding specific patterns of traumatic elbow instability is critical for counseling and managing patients, as recognizing the precise injury pattern prevents chronic instability, pain, and weakness [6], [8].

Elbow instability injuries represent an infrequent but serious source of disability for select NCAA athletes [9]. Simple elbow dislocations are usually managed by closed reduction and early motion [16]. Most are readily managed nonoperatively and are amenable to early mobilization [25]. Recurrent instability is uncommon in simple dislocations due to intrinsic bony stability [16]. Few patients with simple dislocations develop complications requiring surgery [15]; those who do most commonly undergo soft-tissue stabilization or contracture release within 4 years of the injury [15].

Posterolateral rotatory instability presents with clicking, locking, or recurrent dislocation [24]. This condition is caused by insufficiency of the lateral ulnar collateral ligament [24]. In a series of patients with lateral collateral ligament instability, all experienced resolution of their symptoms [10].

Elbow arthroscopy is a valid and safe option for diagnosing both acute [3] and chronic elbow instability [3]. Standardized stress radiographs with comparison to the uninjured side can reveal increased medial joint gapping, aiding in the diagnosis of a complete UCL injury [35]. Ultrasound serves as a dynamic test to assess UCL thickness, integrity, and joint gapping with valgus stress [35]. Increased medial laxity is associated with UCL injury, although throwers may exhibit slight increases in medial laxity that are adaptive [35].

Standard elbow radiographs reveal avulsion fractures, posterior medial olecranon osteophytes associated with valgus extension overload syndrome, osteochondral lesions, ossicles, and calcifications within the UCL in throwing athletes [35]. Chronic complex persistent elbow instability requires customized surgical treatment aimed at elbow stabilizer reconstruction when the ulnohumeral joint is preserved, or joint replacement in case of severe articular degeneration [36].

Investigations

Plain radiography: Careful radiographic evaluation is required to avoid delayed diagnosis of proximal radioulnar translocation with radial neck fracture and elbow dislocation in children [51]. Concomitant vascular lesions should be considered when confronted with elbow dislocations [49].

MRI: In non-operatively treated elbow ulnar collateral ligament injuries, lower MRI grade is objectively associated with higher return to throw [50], higher return to play [50], lower UCLR [50], and higher survival compared to higher grade and ulnar or both-sided tears [50]. Humeral location in these injuries is also objectively associated with higher return to throw [50].

CT: Elbow arthroscopy is a valid and safe option for the diagnosis and treatment of acute elbow instability [3] and chronic elbow instability [3]. It allows for the management of soft tissue lesions in elbow instability with minimal disruption [3] and allows for the management of associated intra-articular bone or cartilage lesions in elbow instability with minimal disruption [3].

Other Considerations: Current concepts of injuries leading to elbow instability in children include recognition and treatment of instability and nontraumatic causes [2]. Understanding patterns of traumatic elbow instability helps surgeons counsel and manage patients with these injuries [6]. Recognizing the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain, and weakness [8]. Elbow instability injuries in NCAA athletes have a number of associated risk factors [9] [13]. An understanding of relevant anatomy and factors associated with elbow stability allows for the application of a systematic algorithm for treating terrible triad injuries [13]. A systematic algorithm for terrible triad injury treatment can help ensure sufficient elbow stability to allow early motion [13]. Early motion in terrible triad injury treatment leads to improved outcomes in most patients [13]. Diagnosing and fixing persistent subclinical instability after surgery is a challenge to prevent the onset of post-traumatic osteoarthritis in terrible triad injuries [14]. Optimal outcomes in coronoid fractures and traumatic elbow instability are founded upon concentric reduction of the elbow [20]. Posterolateral rotatory instability of the elbow is a clinical syndrome caused by insufficiency of the lateral ulnar collateral ligament [24]. An algorithmic approach to the diagnosis and treatment of complex elbow fracture-dislocation injuries can improve diagnostic assessment [30] and improve reconstruction of bony and ligamentous restraints [30]. Reconstruction of bony and ligamentous restraints in complex elbow fracture-dislocations aims to restore a stable and functional elbow [30]. Rotationally unstable simple elbow dislocations can be stabilized by repositioning the forearm [4].

Treatment

Non-Operative Management

Conservative treatment with early functional training is the first-line therapy for simple elbow dislocation [46]. Rehabilitation programs for rotationally unstable simple elbow dislocations should stress early active range of motion through the stable arc of motion [4]. Elbow valgus instability in the throwing athlete may be managed nonsurgically [43].

Operative Management

Indications: Surgical management is indicated when the elbow remains unstable, with the lateral ulnar collateral ligament being the most critical structure to repair or reconstruct [32]. 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 [21]. The primary goal of treatment for nonacute traumatic elbow instability with persistent ulnohumeral dislocation or subluxation is stable reduction of the ulnohumeral joint and functional elbow motion [12]. Optimal outcomes for traumatic elbow instability are founded upon concentric reduction of the elbow [20].

Surgical Approach / Technique: Use of a standard surgical protocol for elbow dislocations with radial head and coronoid fractures restored sufficient stability to allow early motion postoperatively, enhancing functional outcome [17]. Both Jobe and Docking techniques are safe and effective for lateral collateral ulnar ligament reconstruction in posterolateral rotatory instability of the elbow [27].

Other Considerations: A small proportion (2%) of patients with simple elbow dislocations require surgical intervention [7]. 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 [15].

Arthroscopic Management

Elbow arthroscopy allows for the management of soft tissue lesions and associated intra-articular bone or cartilage lesions with minimal disruption [3]. Elbow arthroscopy is not necessarily contraindicated in patients with a subluxating or transposed ulnar nerve [39].

Complications

Instability: Nonoperative management of simple elbow dislocations yields good long-term outcomes [7]. Approximately 2% of patients treated nonoperatively require subsequent surgical intervention [7], while 8% develop persistent instability symptoms [7]. Recurrent instability is uncommon after simple elbow dislocations due to intrinsic bony stability [16]. Complications after simple elbow dislocation requiring surgery most commonly involve soft-tissue stabilization or contracture release within 4 years of the injury [15]. Persistent subclinical instability after surgery is a challenge that can lead to the onset of post-traumatic osteoarthritis [14].

Prosthetic Instability: Instability is the major complication of unlinked total elbow arthroplasty, often requiring revision [31]. Linked total elbow arthroplasty is preferred for patients with posttraumatic articular damage, ligamentous instability, deformity, or bone loss [31].

Ligament Reconstruction: Ulnar collateral ligament reconstruction (UCLR) demonstrates low complication and revision rates at minimum 48-month mean follow-up [42].

Other Considerations: There is a distinct difference in the complication profile between external fixation and internal joint stabilization (IJS) for traumatic elbow instability [44].

Recovery

Non-operative management of simple elbow dislocations yields good long-term outcomes [7]. Approximately 2% of patients treated nonoperatively require subsequent surgical intervention [7], while approximately 8% develop persistent instability symptoms [7]. Patients requiring surgery most commonly undergo soft-tissue stabilisation or contracture release within 4 years of the injury [15].

Light activity (weeks): Evidence does not specify a week range for light activity or desk work.

Full activity (months): Athletes with elbow dislocation demonstrate high return to sport rates, with most returning within 10 weeks [45].

Complete recovery / outcome plateau (months): Evidence does not specify a month range for complete recovery or outcome plateau.

Rehabilitation protocol: 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 these injuries [17].

Functional milestones: Athletes with elbow dislocation demonstrate excellent functional outcomes [45].

Other Considerations: Recognizing the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain, and weakness in complex elbow instability [8].

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)
  • [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. [4] (10.1016/j.hcl.2015.06.002)
  • [L4] Elbow arthroscopy is a valuable tool in the diagnosis and management of chronic elbow instability. [5] (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. [6] (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. [7] (10.1177/1758573217694163)
  • [Paper] Recognising the precise pattern of injury is critical in restoring elbow function and preventing chronic instability, pain and weakness. [8] (10.1016/j.injury.2013.09.032)
  • [L4] Elbow instability injuries are an infrequent but serious source of disability for select NCAA athletes, with a number of associated risk factors. [9] (10.1177/2325967117750105)
  • [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] The primary goal of treatment is stable reduction of the ulnohumeral joint and functional elbow motion. [12] (10.2106/jbjs.m.00817)
  • [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. [13] (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. [14] (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. [15] (10.1016/j.injury.2015.02.009)
  • [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] [19] (10.1136/jisakos-2019-000316)
  • [L5] Optimal outcomes are founded upon concentric reduction of the elbow. [20] (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. [21] (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. [22] (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. [23] (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. [24] (10.5435/00124635-200411000-00005)
  • [L5] Most simple elbow dislocations are readily managed nonoperatively and are amenable to early mobilization. [25] (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. [26] (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. [27] (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. [28] (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. [29] (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. [30] (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. [31] (10.1016/j.hcl.2007.11.002)
  • [L5] Surgical management is indicated when the elbow remains unstable, with the lateral ulnar collateral ligament being the most critical structure to repair or reconstruct. [32] (10.1016/j.hcl.2016.08.003)
  • [L5] [33] (10.1016/j.csm.2004.04.014)
  • [L5] [35] (10.1016/j.jhsa.2021.11.026)
  • [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. [36] (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. [37] (10.1016/j.jseint.2022.12.002)
  • [L4] PLRI of the elbow remains to be fully understood. [38] (10.1016/j.arthro.2014.02.029)
  • [L4] Elbow arthroscopy is not necessarily contraindicated in patients with a subluxating or transposed ulnar nerve. [39] (10.1016/j.arthro.2009.04.024)
  • [L4] UCLR provides excellent patient-reported and clinical outcomes to patients at medium-term follow-up with low complication and revision rates. [42] (10.1136/jisakos-2021-000614)
  • [L5] Elbow valgus instability in the throwing athlete may be managed either nonsurgically or surgically. [43] (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. [44] (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. [45] (10.1177/23259671261419505)
  • [L1] Conservative treatment with early functional training of the elbow remains the first-line therapy for simple elbow dislocation. [46] (10.1186/s12891-024-07260-0)
  • [L5] [47] (10.1016/j.hcl.2020.07.011)
  • [Case_report] This case should sensitize the readers for concomitant vascular lesions when confronted with elbow dislocations. [49] (10.1007/s00167-010-1202-5)
  • [L3] Lower MRI grade and humeral location were objectively associated with higher return to throw, higher return to play, lower UCLR, and higher survival compared to higher grade and ulnar or both-sided tears. [50] (10.1177/2325967119s00311)
  • [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. [51] (10.1007/s00402-013-1820-8)

See Also

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

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

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

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

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

[9] 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

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

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

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

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

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

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

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

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

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

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

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

[26] 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

[27] 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

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

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

[30] 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

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

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

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

[35] Elbow Ulnar Collateral Ligament Injuries in Throwing Athletes: Diagnosis and Management. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.11.026

[36] 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

[37] “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

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

[39] 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

[42] 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

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

[44] 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

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

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

[47] Elbow Fracture-Dislocations. Hand Clinics. 2020. DOI: 10.1016/j.hcl.2020.07.011

[49] 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

[50] Outcomes of Non-Operatively Treated Elbow Ulnar Collateral Ligament Injuries in Professional Baseball Players by Magnetic Resonance Imaging Tear Grade and Location. Orthopaedic Journal of Sports Medicine. 2019. DOI: 10.1177/2325967119s00311

[51] 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

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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.