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Case Reports
. 2024 Dec 28;18(1):642.
doi: 10.1186/s13256-024-04974-6.

A staged approach to managing a combination of a terrible triad injury and an Essex-Lopresti fracture dislocation: an open forearm crush injury-a case report

Abdulla Abdelwahab  1 , Ahmed Khairy Farahat Elsayed  2 , Hamed Badawi  3
Affiliations
Case Reports

A staged approach to managing a combination of a terrible triad injury and an Essex-Lopresti fracture dislocation: an open forearm crush injury-a case report

Abdulla Abdelwahab et al. J Med Case Rep. .

Abstract

Background: Open and crushed forearm injury is a complex and rare injury affecting the upper extremity. It results in damage to various structures, including bones, soft tissues, and neurovascular bundles, ultimately leading to functional impairment. Typically, these injuries occur owing to high-energy trauma.

Case presentation: A 19-year-old South Asian male was seen at our trauma center emergency department following an accident where his arm got entangled in a machine belt. He sustained a serious open injury on his left forearm, spanning from the elbow to the wrist, affecting the proximal radio-ulnar joint, ulna bone, interosseous membrane, and distal radio-ulnar joint. The initial plan of care involved stabilizing the injury using an external fixator, while reconstructive surgery was scheduled for a later date.

Conclusion: Timely intervention for wound debridement and joint stabilization plays a crucial role in the restoration of a crushed forearm. Following this, a collaborative effort from a multidisciplinary team becomes essential. Planning multiple surgeries is important, with the primary goal of achieving early range of motion of the elbow and wrist to prevent stiffness. This comprehensive approach aims at optimizing the recovery and functionality of the affected limb. The combination of early intervention, damage control surgeries, and carefully planned procedures sets the foundation for successful management of a crushed and open forearm injury. Furthermore, early range of motion and physiotherapy rehabilitation has a key role in stiffness prevention and the restoration of function.

Keywords: Case report; Crush injury; Forearm; Interosseous membrane; Open fracture.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Informed written consent to participate was obtained, but ethical approval is not required. Human subjects: consent was obtained or waived by all participants in this study. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in Chief of the journal. Competing interests: In compliance with the ICMJE uniform disclosure form, all authors declare the following: payment/services info: all authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: all authors have declared that they have no financial relationships at present or within the previous 3 years with any organizations that might have an interest in the submitted work. Other relationships: all authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
A Severe crush forearm injury with exposed bone, muscles, and interosseous membrane. B Left upper limb X-ray showing elbow dislocation, distal ulnar bone fracture, and possible disruption of interosseous membrane
Fig. 2
Fig. 2
Intraoperative clinical images (A) and X-ray fluoroscopy (B) showing application of external fixator to the left elbow and Kirschner wire fixation of the radius and ulna and distal ulna
Fig. 3
Fig. 3
Postoperative anteroposterior and lateral X-rays of the left forearm showing elbow fixation via external fixator and distal ulna fixation using two Kirschner wires and radio-ulnar transfixing with three Kirschner wires
Fig. 4
Fig. 4
Postoperative anteroposterior and lateral X-rays of the left forearm after removal of the external fixators. The two distal ulnar Kirschner wires and the three radio-ulnar transfixing Kirschner wires can still be seen in situ
Fig. 5
Fig. 5
Final anteroposterior and lateral X-rays of the elbow showing (A) two anchor sutures and forearm (B) clinical photos (C) of the patient flexing and extending the elbow and supinating and pronating the forearm at follow-up exactly one month from sustaining the injury
See this image and copyright information in PMC

References

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