An Unusual Terrible Triad Variant Associated with an Essex-Lopresti Injury

Abstract

Essex-Lopresti injuries and terrible triad injuries of the elbow are rare injuries that typically result from high-energy trauma such as falling from a height or a motor vehicle collision. However, the combination of an Essex-Lopresti injury and terrible triad injury is unique and poses a significant challenge for treatment as these injuries are independently associated with poor functional outcomes if they are not acutely diagnosed. We describe a case of a 19-year-old who presented with an unusual variant of a terrible triad injury associated with an Essex-Lopresti injury. The patient had a distal radioulnar joint (DRUJ) and elbow dislocation, a radial head and coronoid process fracture, and a distal radius fracture. Almost a reverse Essex-Lopresti, this injury was successfully managed with open reduction and repair of the distal radius, radial head, and damaged ligaments in the elbow, along with an internal joint stabilizer (IJS).

Variants of terrible triad of the elbow: A brief literature review

“…Similarly, Luis M. Salazar et al [10] in their case report mentions about associated ipsilateral Essex-Lopresti injury with terrible triad, which was fixed with IJS system, radial head was fixed with smaller screws. Patient had a good outcome following the surgery [10] .…”

“…Similarly, Luis M. Salazar et al [10] in their case report mentions about associated ipsilateral Essex-Lopresti injury with terrible triad, which was fixed with IJS system, radial head was fixed with smaller screws. Patient had a good outcome following the surgery [10] . One case out of 15 cases as reported by Bhavsar et al 9 had a terrible triad variant injury (i.e., medial condyle fracture with LCL injury along with classical triad) further details like the mechanism of injury were not specified.…”

Revision management of a 17-year-old patient initially treated with radial head excision following terrible triad injury with associated Essex Lopresti

“…There is limited evidence for acute management of terrible triad injury with associated Essex-Lopresti. Salazar et al 29 reported on a 19-year-old with this injury pattern and concomitant distal radius fracture. The LCLC was repaired, the radial head fracture was fixed with screws, a dorsal spanning plate was applied to the distal radius, and the IJS was used for temporary stabilization.…”

“…5 ). 29 , 32 The proximal radius was prepared for arthroplasty according to the previously described technique (Align; Skeletal Dynamics, Miami, FL, USA). 11 , 21 Prosthetic length was determined in relation to the corner formed by the lesser and greater sigmoid notch when evaluated on a true anteroposterior fluoroscopic image with the forearm in supination.…”

Defining acute Essex-Lopresti injuries is problematic and variable: a systematic review

“…Our initial search revealed 47 eligible articles ( 6 , 7 , 11 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ) ( Fig. 1 ), of which 27 were case reports and 20 were case series.…”