Terrible triad of the elbow with an ipsilateral Essex-Lopresti injury: case report

Abstract

Terrible triad of the elbow and the Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome. We present the case of a unique association of the two injuries with an elbow dislocation, radial and coronoid process fractures and a distal radioulnar joint dislocation due to an interosseous membrane rupture. The case was managed with closed reduction of the elbow dislocation and distal radioulnar joint followed by open reduction and repair of the damaged structures in the elbow and an unloading of the interosseous membrane. A high index of suspicion with a detailed examination of the elbow, forearm and wrist associated to a comprehensive imaging were mandatory for a complete diagnosis and an adequate treatment. Six months after the accident, the patient made a good recovery.

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

“…Variants of an ELI coupled with another fracture-dislocation in the elbow are sparsely reported in the literature. More specifically, an ELI and a terrible triad in the elbow, including an elbow dislocation and a radial head and coronoid process fracture, has only been reported once in the literature [ 6 ]. Also, one case of reverse ELI with anteromedial radial head dislocation, DRUJ dislocation, and distal radius fracture has been reported [ 10 ].…”

“…If the DRUJ dislocation and IOM rupture are not recognized in the acute setting, these injuries can result in chronic complications such as wrist pain, subluxation, and further translation of the radius [ 4 , 5 ]. Even more rare are variants of Essex-Lopresti injuries (ELIs) associated with a terrible triad in the ipsilateral elbow [ 6 ]. A terrible triad injury is composed of an elbow dislocation, a radial head or neck fracture, and a coronoid fracture.…”

Surgical management of medial and lateral elbow instability secondary to acute atypical complex elbow dislocation: Case report and literature review

“…Ramzi et al also reported a case where elbow dislocation had an unusual combined presentation that was classified as ranging between a terrible triad injury and an Essex-Lopresti injury. The case was treated with closed reduction of the elbow and distal radioulnar joint, followed by MCL and LCL repair, resulting in a stable elbow without coronoid fracture fixation [ 13 ].…”

Terrible triad of the elbow and associated variants: a systematic review

“…Terrible Triad VariantsFour of the 19 included articles described variants of the typical TTE. Group 2 had a total of four patients (three males and one female) with a mean age of 22.35 years old (range[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]. Patient characteristics, MOI, TTE variant, and other injuries for each study are described in TableIII.J o u r n a l P r e -p r o o fTerrible Triad of the Elbow and Associated Variants Desai et al7 reported the case of a 25-year-old polytrauma patient who sustained a TTE variant consisting of a posterior elbow dislocation, coronoid process, and capitellum fractures.…”