The elbow joint combines three articulations in one synovial cavity: the humeroulnar hinge (primary flexion-extension), the radiohumeral ball-and-socket (rotation + flexion), and the proximal radioulnar pivot (forearm rotation). It is one of the most congruent and stable joints in the body, requiring significant force to dislocate. The elbow capsule distends maximally at 80 degrees of flexion, the position of comfort after effusion.
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Elbow dislocation is the most common major joint dislocation in children and second most common in adults. Posterior dislocations from FOOSH injuries are reduced by traction-countertraction. The terrible triad (posterior dislocation + radial head fracture + coronoid fracture) requires surgical repair of all three components for stability. Because all three articulations share one cavity, any effusion or haemarthrosis lifts the anterior and posterior fat pads; a visible posterior fat pad on a lateral radiograph after trauma suggests an occult fracture. The whole joint can be aspirated or injected through the lateral soft spot between the radial head, lateral epicondyle and olecranon.
Posterior elbow dislocation from FOOSH requiring closed reduction under adequate analgesia with assessment for terrible triad pattern needing surgical repair.
Blood or fluid in the shared joint cavity displaces the fat pads, so a visible posterior fat pad after trauma is treated as an occult fracture (often radial head in adults, supracondylar in children) until proven otherwise.
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