Recognition of arterial injury in elbow dislocation

The clinical presentation of patients with elbow dislocations was reviewed to identify those factors indicating an increased risk for arterial injury. Sixty-two patients were treated for 63 elbow dislocations between January 1981 and July 1991. Eight patients (13%) sustained a concomitant arterial injury involving the brachial (7) and radial (1) arteries. Three clinical findings, absence of a radial pulse, open dislocation, and presence of systemic injuries, were correlated with arterial injury. A palpable radial pulse was absent in six (75%) patients with an arterial injury but in only two (4%) with normal vessels (p < 0.0001, chi square). Five (33%) open dislocations had an associated arterial injury, whereas three (6%) arterial injuries occurred in closed dislocations (p < 0.006, chi square). Systemic injury occurred in five dislocations (63%) with arterial injuries and 14 dislocations (25%) without arterial injury (p < 0.04, chi square). Multivariate analysis showed that absence of a radial pulse was the only factor that significantly predicted arterial injury (p < 0.0001). Although most elbow dislocations are not associated with arterial injury, absence of a radial pulse or presence of an open dislocation or both should alert the clinician to the increased possibility of an associated vascular injury.