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.

Keywords: Elbow dislocation; Essex Lopresti Injury; Instability; Interosseous membrane; Terrible triad.

Figure 1

(A) X-ray of elbow profile shows the posterior elbow dislocation with a detached anterior fragment from the coronoid; (B) three-fourth X-ray of the forearm before the reduction demonstrates significant ulnar negative variance.

Figure 2

3D reconstruction CT scan of the elbow shows a radioulnar proximal dislocation with O’Driscoll type 2-2 anteromedial fracture.

Figure 3

Anteroposterior X-ray of the wrist showing the DRUJ reduction and the TightRope stabilization.

Figure 4

Clinical assessment of the post-operative ROM (A and B).