Adult elbow fractures-posterior dislocations are mostly unstable because of fracture and ligament damage, and usually require surgical treatment. Prolonged immobilization can significantly increase joint stiffness, so incision and stabilization should be performed to allow for early movement. Neurovascular injury Complicated brachial artery injury in elbow dislocation is rare, but when it occurs it is catastrophic. Early diagnosis is important, and if treatment has been delayed, a forearm fasciotomy must be performed to reduce the chance of fascial gap syndrome. Intimal tears can cause delayed arterial thrombosis, so all patients with elbow dislocation should be closely monitored. Elbow dislocations can injure the median nerve, ulnar nerve, or anterior interosseous nerve. Most have simple nerve palsy and can recover quickly. Treatment Closed repositioning should be performed as soon as possible with careful flexion and extension of the elbow joint. If there is a subluxation or impending subluxation from full extension to 30° or more, this indicates instability and requires surgical fixation. If the elbow joint is stable, a long-arm posterior plaster brace can be used to fix the elbow joint at 90° of flexion. Monitor the patient closely and if subluxation or spontaneous re-dislocation occurs, surgically stabilize the elbow joint. Regan & Morrey coronoid fracture types: Type I: simple coronoid tip fracture; Type II: fracture involving less than 50% of the coronoid process; Type III: fracture involving more than 50% of the coronoid process. Type I and II coronoid fractures are fixed with coarse sutures, which are braided to close the humerus muscle and its coronoid attachment point, passed through two holes in the proximal ulna, and then firmly tied. Type III coronoid fractures are fixed by interlocking bone block fixation technique with screws or with coronoid plates. The radial head is an important stabilizing structure of the elbow joint. If the radial head can still be preserved, incisional repositioning and internal fixation should be preferred. If the radial head cannot be preserved, the medial collateral ligament and flexor-pronator muscle group should be repaired. Pugh recommends a surgical protocol that uses a posterolateral approach to repair the damaged structures sequentially from deep to superficial. The elbow is immobilized in 90° flexion with a posterior plaster brace. Active activity is initiated 2-3 weeks after surgery using a controlled brace that limits extension. Complications Stiffness, reoccurrence of instability and post-traumatic arthritis are common complications of elbow fracture-posterior dislocation. To prevent arthritic changes, intra-articular fractures must be anatomically repositioned. Heterotopic ossification is common, including calcium deposits in the collateral ligaments and joint capsule, but rarely requires treatment. Strong internal fixation, thorough flushing of soft tissue after fracture repair, and early activity may reduce heterotopic ossification. Indomethacin (anti-inflammatory pain) can be applied, and radiotherapy is not recommended to prevent heterotopic ossification. Removal of heterotopic bone to improve joint motion should be delayed until after 12 months of injury.