Floating forearm associated with terrible triad injury and Essex-Lopresti injury: a case report and literature review

Complex elbow dislocations are injuries in which there is a significant risk of long-term disability. The combination of elbow dislocation with both radial head and coronoid process fracture is particularly challenging to treat and, as such, has been termed terrible triad injury (TTI) of the elbow.23 TTI is typically caused by high-energy falls onto an outstretched hand.16 Although the treatment of TTI has evolved over the last decade, clinical results are still unsatisfactory.38 Essex-Lopresti injury (ELI) is also a severe upper limb injury that is difficult to manage. ELI consists of a characteristic triad: a comminuted radial head fracture, disruption of the distal radioulnar joint (DRUJ), and tearing of the interosseous membrane (IOM).15 Similar to TTI, ELI occurs when a high-energy load is axially applied to the forearm, usually as a result of a fall on an outstretched hand.15 In recent years, a rare pattern of a whole forearm injury, that is, floating forearm—the ipsilateral bipolar dislocation of the forearm—has been described.3,22 This injury involves a combination of elbow dislocation and ipsilateral perilunate dislocation.22 TTI and ELI are both relatively rare injuries; therefore, floating forearm is extremely rare. We present the first case report of floating forearm associated with both TTI and ELI.