Floating forearm with pure dislocations

Tripolar Dislocation: Elbow Terrible Triad-Essex-Lopresti Injury-Trans-scaphoid Perilunate Dislocation: A Case Report

CASE

A 23-year-old man presented with a right upper limb injury after a 10-m fall. Initial evaluation demonstrated a terrible triad elbow injury associated with a trans-scaphoid perilunate dislocation. Elbow stabilization with radial head replacement and carpal fixation was performed. Radiographs on postoperative day 7 demonstrated an ipsilateral Essex-Lopresti injury, which had been initially missed, and revision surgery was performed to reconstruct the interosseous membrane.

CONCLUSION

Surgeons should maintain a high degree of suspicion for an ipsilateral Essex-Lopresti injury in patients with a terrible triad elbow fracture-dislocation in combination with a trans-scaphoid perilunate dislocation. Both preoperative imaging, including the contralateral side, and intraoperative evaluation are recommended to rule out longitudinal instability of the forearm in the setting of combined wrist and elbow fracture-dislocations.

Forearm floating with a terrible triad in the elbow after fall, case report

Perilunate fracture dislocation with an elbow dislocation, it is referred to as a floating forearm. Very few cases have been described worldwide. We report a case of a 37-year-old man diagnosed with a floating forearm (trans-scaphoid perilunate fracture dislocation combined with a terrible triad injury), after a fall of the top of an olive tree. Urgent closed reduction of the elbow and wrist was obtained. A double approach to the wrist was used: dorsal approach to fix the scaphoid and to reduce the carpus and a volar approach to release the median nerve and repair the volar capsule. A lateral approach to the elbow was performed to fix the radial head and to repair the lateral collateral ligament. At 3 months postoperative, the patient had no pain in the elbow and in the wrist. He returned to Work with some restriction at 4-month post operatively.