Elbow instability following injury in children is uncommon. Most children heal their fractures and ligament injuries uneventfully following dislocation and/or fracture. There are occasionally children that have persistent posterolateral or medial valgus instability. Posterolateral rotatory instability results is recurrent elbow subluxation/dislocation and medial instability results in pain during valgus stress, such as throwing or weight bearing. These entities are distinctly different and disparate with regard to diagnosis and treatment. Hence, a separate discussion is necessary and will be divided accordingly.
Lateral pivot-shift test under anesthesia. Extension of the elbow coupled with forearm supination and axial load yields posterolateral instability (Courtesy of Shriners Hospital for Children, Philadelphia) (WMV 2036 kb)
Overt valgus instability under general anesthesia that could not be produced in the awake adolescent patient (Courtesy of Shriners Hospital for Children, Philadelphia) (WMV 2719 kb)