Recurrent dislocation of the elbow.

Recurrent dislocation of the elbow is uncommon, but in the past three years eighteen cases have been discovered through the cooperation of colleagues in Liverpool, Birmingham and Oswestry. The pathology of this condition has not been well described nor is there a standard method of treatment. A study of the anatomy, mechanism of injury and clinical features suggested that there was a constant capsular defect with secondary articular changes analogous to those that occur in recurrent dislocation of the shoulder. Eight elbows have been treated during the past three years by an operation to repair the capsular defect. Recurrent dislocation of the elbow usually follows simple traumatic dislocation, but there may be congenital laxity of the capsule in some cases, and bilateral recurrent spontaneous dislocation has been reported (Much 1936). Furthermore, both simple and recurrent dislocations of the elbow are commonest in children and adolescents, in whom there is greater laxity of the ligaments than is found in adults. It is interesting that most children under the age of ten are able to hyperextend the elbow joint, but gradually lose this ability during adolescence. The natural stability of the elbow against dislocation is provided partly by the shape of the articular surfaces but also by the triangular collateral ligaments. In flexion, posterior dislocation is prevented by the impaction of the radial head and coronoid process against their humeral articulations, but in full extension, dislocation is prevented solely by the ligaments.