Radial nerve palsy after the use of an adjuvant hinged external fixator in a complex fracture–dislocation of the elbow: a case report and review of the literature

BACKGROUND: The combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture is known as “terrible triad” injury of the elbow. This injury is one of the most challenging injuries of the musculoskeletal system and almost always causes instability of the elbow. The use of an adjuvant hinged external fixator in such injuries is still debated. CASE PRESENTATION: In this case report we present a case of radial nerve palsy after setting up an adjuvant hinged external fixator in a complex fracture–dislocation of the elbow. The patient was a 39-year-old white man. A revision of his radial nerve was undertaken at 7 weeks. A radial nerve injury at two levels facing the humeral apex pins was found intraoperatively; the pins were carefully removed and partial nerve grafts done. The functional outcome at 18 months was excellent. CONCLUSION: This case report highlights that the use of an adjuvant hinged external fixator in complex fracture –dislocation of the elbow is technically demanding and not without risk.