Elbow fracture-dislocation (terrible triad)

Case contributed by Dr Henry Knipe

Presentation

Football injury - unable to straighten arm.

Patient Data

Age: 30
Gender: Male

Elbow

Modality: X-ray

Elbow dislocation with posterolateral displacement of the proximal radius and ulna. Intra-articular radial head fracture. Bone chip projects inferiorly to the distal humerus - unclear origin. Large joint effusion. 

Elbow dislocation was reduced under propofol sedation. 

Elbow

Modality: CT

Comminuted and displaced fracture of the radial head with the distal humerus impacting and separating the distal fracture fragment, which lies posteriorly to the distal humerus and results in anterior subluxation of the elbow joint. Undisplaced chip fracture through the medial ulna at its articulation with the proximal radius. Small displaced fracture of the coronoid process. No humeral fracture imaged. Joint effusion with small locule of gas noted. 

Case Discussion

This injury is called the terrible triad of the elbow - posterior elbow dislocation, coronoid process fracture and radial head fracture - due to often poor outcomes. 

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Case Information

rID: 27791
Case created: 20th Feb 2014
Last edited: 31st Aug 2015
Inclusion in quiz mode: Included

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