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

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Luis M. Salazar ◽  
Abdullah Ghali ◽  
Jose M. Gutierrez-Naranjo ◽  
Thomas L. Hand ◽  
Anil K. Dutta
Keyword(s):  
Distal Radius ◽  
Radial Head ◽  
Motor Vehicle ◽  
Elbow Dislocation ◽  
Distal Radioulnar Joint ◽  
High Energy ◽  
Terrible Triad ◽  
Internal Joint ◽  
Unusual Variant ◽  
Essex Lopresti

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).

scholarly journals Bilateral radial head fracture with unilateral terrible triad injury in a military

2020 ◽  
Author(s):  
MOURAD BENNANI ◽  
Taoufik Cherrad ◽  
Mouad Guendbar ◽  
Hassan Zejjari ◽  
Jamal Louaste ◽  
...  
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Elbow Dislocation ◽  
Lateral Collateral Ligament ◽  
High Energy ◽  
Rehabilitation Program ◽  
Surgical Indication ◽  
Terrible Triad ◽  
Elbow Injury ◽  
The Right

Abstract Background: The combination of coronoid process fracture, radial head fracture, and elbow dislocation has earned the moniker “terrible triad” by virtue of its challenging treatment and historically poor outcomes. Bilateral radial head fracture with unilateral terrible triad injury is an unprecedented presentation. It raises questions regarding the mechanism of injury, the surgical indication and the rehabilitation program. Case presentation: We report a case of a 29-year-old man presenting a unilateral terrible triad injury of the right elbow and a left radial head fracture after he fell off his motorcycle. The patient underwent open reduction and internal fixation of the radial head with repair of the lateral collateral ligament for the right elbow while the left radial head fracture was treated by a short-term immobilization in a posterior splint. We have reached good results 2 years after the injury: The Mayo Elbow Performance Score was 100 for both elbows. Conclusion: The few available data suggest that bilateral elbow injury involving a terrible triad occurs mainly in male young patient as a result of a high energy trauma. Bilateral radial head fracture with unilateral terrible triad injury is unprecedented. Well adapted surgical indication followed by optimal rehabilitation program are the two keys to obtain good results.

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

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Zakaria Ramzi ◽  
Jordi Juanos Cabans ◽  
Harold Jennart
Keyword(s):  
Elbow Dislocation ◽  
Detailed Examination ◽  
Distal Radioulnar Joint ◽  
Interosseous Membrane ◽  
Terrible Triad ◽  
Adequate Treatment ◽  
Radioulnar Joint ◽  
Membrane Rupture ◽  
High Index Of Suspicion ◽  
Essex Lopresti

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.

Radius and Ulna Trauma

2019 ◽  
pp. 65-67
Author(s):  
Michael O’Keeffe ◽  
Kiran Khursid ◽  
Peter L. Munk ◽  
Mihra S. Taljanovic
Keyword(s):  
Radial Head ◽  
Distal Radioulnar Joint ◽  
Monteggia Fracture ◽  
Radial Head Fractures ◽  
Type Iv ◽  
Ulnar Fracture ◽  
Fracture Dislocations ◽  
Diaphyseal Fractures ◽  
Both Bones ◽  
Essex Lopresti

Chapter 15 discusses radius and ulna trauma. Forearm fractures are common and may be isolated to the ulna or more commonly involve both bones. Fractures of the radius or ulna are usually because of direct trauma and are often displaced. Depending on their complexity, isolated fractures of the ulnar diaphysis may be treated nonoperatively or operatively whereas both bone (radius and ulna) diaphyseal fractures are typically treated operatively. Galeazzi fracture-dislocations are comprised of radial diaphyseal fractures in association with distal radioulnar joint (DRUJ) dislocation/subluxation. Monteggia fracture-dislocations are comprised of a proximal ulnar fracture in association with radial head dislocation. In type IV Monteggia injuries, there is an additional fracture of the proximal radial diaphysis. Essex-Lopresti fracture-dislocations include radial head fractures in association with DRUJ dislocation/subluxation.

Distal radius fracture with ipsilateral elbow dislocation: a rare but challenging injury

2021 ◽  
Author(s):  
Henrik Constantin Bäcker ◽  
Kathi Thiele ◽  
Chia H. Wu ◽  
Philipp Moroder ◽  
Ulrich Stoeckle ◽  
...  
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Elbow Dislocation ◽  
High Energy ◽  
Low Energy ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Associated Injuries ◽  
Radius Fractures ◽  
High Energy Trauma

Abstract IntroductionDistal radius fractures are common and account for approximately 14% to 18% of all adult extremity injuries. On rare occasions, ipsilateral elbow dislocation can be observed additionally. The aim of this study was to analyse the mechanism and level of injury, demographics, and associated injuries in distal radius fractures with ipsilateral elbow dislocations.Methods:Between 2012 and 2019, we searched our trauma database for distal radius fractures with ipsilateral elbow dislocations. All patients older than 18 years old were included. Data on demographics, mechanism of injury, level of energy, and subsequent treatments were collected. ResultsA total of 7 patients were identified. The mean age was 68.7 ± 13.3 years old and the left side was involved in 71.4% of cases. Females were affected in 85.7% (n=6/7) of cases. All suffered from low-energy mechanism without other orthopaedic injuries at a mean age of 71.5 ± 12.3 years old. The one male patient that was included suffered from high-energy trauma at 52 years of age. Most commonly, posterior elbow dislocations were observed (66.7%; n=4/6). Distal radius fracture patterns include two C2, two C3, and one case each of C1-type and B1-type fracture pattern in the low energy group. In the group of patients who sustained high energy trauma, associated injuries include a concomitant open elbow dislocation, an ulnar artery rupture and damage to the flexor digitorum superficialis muscle.ConclusionAlthough distal radius fracture with ipsilateral elbow dislocation is thought to be resulting from high energy injuries, this study shows that most patients were elderly females suffering from low energy mechanisms. If not suspected, this could be missed especially in the setting of altered mental status. Careful physical examination of one joint proximal and one joint distal to the presumed site of injury is recommended.

scholarly journals The “floating ulna” injury in adults: a case report, literature review and proposed injury classification

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tian He ◽  
Xin Wang ◽  
Shui Sun ◽  
Lugang Zhou
Keyword(s):  
Dynamic Compression ◽  
Elbow Dislocation ◽  
Shaft Fracture ◽  
Distal Radioulnar Joint ◽  
High Energy ◽  
Injury Pattern ◽  
Rare Injury ◽  
Galeazzi Fracture ◽  
Instability Range ◽  
Type Of Injury

Abstract Background Ipsilateral Galeazzi fracture with elbow dislocation, namely the “floating ulna” injury, is a rare injury pattern. A few reports have described this type of injury and its treatment. Case presentation A 33-year-old female at 38+ weeks gestational age presented with Galeazzi fracture and posterolateral elbow dislocation of the left upper extremity. The patient was treated with closed reduction of the elbow, open reduction, and internal fixation of the radial shaft fracture with a dynamic compression plate and K-wire stabilization of the unstable distal radioulnar joint. At the 12-month follow-up, the patient had no pain or signs of instability. Range of motion was 0–135° at the elbow, 70° extension and 80° flexion at the wrist, and 80° supination and 80° pronation at the forearm. Conclusion The “floating ulna” injury is a rare and special injury pattern with ipsilateral Galeazzi fracture and elbow dislocation. This type of injury was likely caused by significant amount of deforming force and the unique position of upper limb when the patient fell from a height of 1–2 m in high-energy trauma.

The Essex–Lopresti Lesion: A Variant with a Bony Distal Radioulnar Joint Injury

2006 ◽  
Vol 31 (2) ◽  
pp. 206-207 ◽  
Author(s):  
J. AUYEUNG ◽  
G. BROOME
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Soft Tissue Injuries ◽  
Distal Radioulnar Joint ◽  
Joint Injury ◽  
Radioulnar Joint ◽  
Membrane Rupture ◽  
Ulnar Head ◽  
Proximal Migration ◽  
Essex Lopresti

The Essex–Lopresti lesion is an unusual injury, consisting of a radial head or neck fracture, distal radioulnar joint (DRUJ) injury and interosseous membrane rupture. To date, all reported Essex–Lopresti lesions have consisted of soft tissue injuries at the DRUJ. We present a case of an Essex–Lopresti lesion with a bony variant, in which the DRUJ injury consisted of an ulnar head fracture associated with radial head fracture and acute proximal migration of the radius. The management involved plating of the ulnar head fracture and titanium replacement of the radial head.

scholarly journals High-Energy Blast Injury Requiring Transradial Amputation with Associated Essex Lopresti and Terrible Triad Injuries of the Elbow: A Rare Presentation

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Paul Knapp ◽  
Dexter Powell ◽  
Ivan Bandovic ◽  
Matthew Coon ◽  
Benjamin Best
Keyword(s):  
Upper Extremity ◽  
Hand Surgery ◽  
Elbow Flexion ◽  
Blast Injury ◽  
High Energy ◽  
Terrible Triad ◽  
Rare Presentation ◽  
Salvage Operation ◽  
Essex Lopresti ◽  
Severe Soft Tissue

Case. Blast injuries to the upper extremity can be devastating and emotionally stressful injuries. We describe a case of a high-energy blast injury to an upper extremity from an explosive. The transfer of energy caused severe soft tissue/bony damage to the hand, but also led to associated Essex Lopresti and terrible triad injuries. The patient required emergent transradial amputation by hand surgery as well as definitive fixation by our orthopaedic team. Conclusion. We describe a unique salvage operation that established forearm pronosupination, elbow flexion, and proper prosthetic fitting. We feel that describing our technique could help others in treating this injury if encountered.

scholarly journals Radial head fractures in young, active patients

2020 ◽  
Vol 15 (4) ◽  
pp. 251-259
Author(s):  
Christopher G. Larsen ◽  
Michael J. Fitzgerald ◽  
Andrew S. Greenberg
Keyword(s):  
Radial Head ◽  
Young Patients ◽  
Elbow Dislocation ◽  
Early Mobilization ◽  
High Energy ◽  
Type I ◽  
Type Ii ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Active Patients

AbstractThe radial head is an important stabilizer of the elbow joint. Radial head fractures are commonly associated with additional injuries to the ligamentous structures of the elbow and can significantly compromise elbow stability. Young patients with radial head fractures are more likely to be male and present after a high-energy mechanism of injury. While not perfect, the Mason classification is the most commonly used classification system and can help to guide the management of radial head fractures. Type I fractures are nondisplaced or minimally displaced (less than 2 mm) and are treated nonoperatively with early mobilization. Type II fractures, which are displaced 2–5 mm, can be treated nonoperatively or with open reduction and internal fixation (ORIF). Type III fractures are comminuted and are most often treated with ORIF or with radial head arthroplasty (RHA). Treatment of fractures with an associated elbow dislocation (Mason type IV) is also with ORIF or RHA depending on the degree of comminution. For all of these injuries, assessment and treatment of associated ligamentous injuries are necessary in conjunction with treatment of the bony injury. Despite a significant body of literature available on radial head fractures, there is controversy regarding the optimal management of type II, III, and IV fractures, especially in young, active patients. Common complications following radial head fractures include stiffness, instability, and posttraumatic osteoarthritis; as such, these injuries can lead to significant disability in young, active patients if not managed appropriately.

UNUSUAL PATTERN OF ESSEX-LOPRESTI INJURY WITH NEGATIVE PLAIN RADIOGRAPHS OF THE WRIST: A CASE REPORT AND LITERATURE REVIEW

Hand Surgery ◽  
2010 ◽  
Vol 15 (01) ◽  
pp. 41-45 ◽  
Author(s):  
Juan Rodriguez-Martin ◽  
Juan Pretell-Mazzini ◽  
Carlos Vidal-Bujanda
Keyword(s):  
Radial Head ◽  
Radial Head Fracture ◽  
Distal Radioulnar Joint ◽  
Interosseous Membrane ◽  
Radioulnar Joint ◽  
Unusual Pattern ◽  
Radial Neck Fracture ◽  
Radial Neck ◽  
Neck Fracture ◽  
Essex Lopresti

The Essex-Lopresti injury consists of a fracture of the radial head, rupture of the interosseous membrane and disruption of the distal radioulnar joint. The greatest challenge with this injury pattern is the diagnosis, because it is frequently missed and the attention usually focused on the elbow joint. In this paper we report an unusual pattern of Essex-Lopresti injury with a radial neck fracture, a tear of the interosseous membrane and a disruption of the distal radioulnar joint in which initial wrist radiographs did not show significative abnormalities. Open reduction and internal fixation for the radial head fracture was performed. Forearm rotation was locked with two Kirschner wires from ulna to radius to allow interosseous membrane to heal. This case is even more difficult to diagnose than classic Essex-Lopresti pattern because of the absence of radius shortening, due to this specific radius fracture pattern, and also the absence of distal radioulnar joint dislocation. When treating a radial head fracture but also a radial neck fracture, interosseous membrane injury should be suspected to avoid misleading in diagnosis.

Sign in / Sign up

Export Citation Format

Share Document