True elbow dislocation in the pediatric patient is uncommon, despite being the second most frequently dislocated joint in adolescents and adults Dislocations of the elbow are usually accompanied by significant soft tissue and bony damage The force and torque of the fall causing the dislocation typically results in posterior and lateral displacement of the radius and ulna, tearing of the anterior capsule, and often rupture of the medial collateral ligament as well ( Fig 111.24 ) In addition to obvious pain, deformity, and significant swelling, in the setting of dislocation the affected forearm may appear shortened and the humeral head can be detected as fullness in the antecubital fossa A thorough neurovascular examination is imperative due to the risk of ulnar and median nerve injury and the potential for trauma to the brachial artery Ulnar nerve lesions typically occur when the dislocation is complicated by intra-articular entrapment of an avulsed medial epicondyle After initial evaluation, patients should be temporarily splinted—avoiding hyperextension—prior to imaging to ensure no further neurovascular injury occurs The AP and lateral radiographs should be assessed for the direction of the dislocation and for the presence of associated fractures FIGURE 111.24 Elbow dislocation in an 8-year-old girl A displaced fracture of the medial epicondyle was evident on the postreduction radiographs