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Takahashi R, Kajita Y, Harada Y. Terrible triad injury of the elbow joint treated with total elbow arthroplasty: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:113-117. [PMID: 38323216 PMCID: PMC10840581 DOI: 10.1016/j.xrrt.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Aichi, Japan
| | - Yohei Harada
- Department of Orthopaedic Surgery, Hiroshima University, Hiroshima, Japan
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Corbet C, Boudissa M, Dao Lena S, Ruatti S, Corcella D, Tonetti J. Surgical treatment of terrible triad of the elbow: Retrospective continuous 50-patient series at 2 years' follow-up. Orthop Traumatol Surg Res 2023; 109:103057. [PMID: 34536597 DOI: 10.1016/j.otsr.2021.103057] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 10/02/2020] [Accepted: 12/31/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Terrible triad (TT) of the elbow is an association at high risk of instability. Treatment aims to restore joint stability. Lateral collateral ligament (LCL) repair is systematic, whereas medial collateral ligament (MCL) repair is only exceptionally necessary. The main aim of the present study was to assess clinical results in TT surgery. The secondary objective was to compare clinical progression with versus without MCL repair. MATERIAL AND METHODS A retrospective study included 50 TTs operated on via an isolated lateral or combined medial-lateral approach. Clinical assessment comprised MEPS, QuickDASH, VAS, flexion-extension and pronation-supination, and return to work and sport. Subgroup analysis was made according to associated MCL repair. RESULTS Fifty patients (19 female, 31 male) were operated on between January 2006 and January 2017. Mean follow-up was 24 months. At last follow-up, mean MEPS was 89.1, VAS 0.7, QuickDASH 16, flexion-extension 114°, and pronation-supination 137°. Only MEPS was significantly improved by MCL repair (p=0.02), with no significant difference in complications. DISCUSSION TT surgery with immediate mobilization gave good long-term functional results, not significantly improved by MCL repair. The lateral approach should be adopted in first line, with the medial approach in second line in case of persistent instability after lateral osteo-ligamentous repair. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Clémentine Corbet
- Service Orthopédie et Traumatologie, CHU Grenoble Alpes, Boulevard de la Chantourne, 38700 La Tronche, France.
| | - Mehdi Boudissa
- Service Orthopédie et Traumatologie, CHU Grenoble Alpes, Boulevard de la Chantourne, 38700 La Tronche, France
| | | | - Sébastien Ruatti
- Service Orthopédie et Traumatologie, CHU Grenoble Alpes, Boulevard de la Chantourne, 38700 La Tronche, France
| | - Denis Corcella
- Service de Chirurgie de la Main et des Brûlés, CHU Grenoble Alpes, Boulevard de la Chantourne, 38700 La Tronche, France
| | - Jérôme Tonetti
- Service Orthopédie et Traumatologie, CHU Grenoble Alpes, Boulevard de la Chantourne, 38700 La Tronche, France
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Li D, Song D, Ni J, Tang S, Gao Z, Li P, Liu X, Xu W. Single Modified Posterior Approach through the Space of the Proximal Radioulnar Joint for Terrible Triad Injury: A Comparative Study. Orthop Surg 2022; 14:2159-2169. [PMID: 35929666 PMCID: PMC9483065 DOI: 10.1111/os.13430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022] Open
Abstract
Objective In order to reduce surgical scars and the risk of neurovascular injury for the treatment of terrible triad injuries of the elbow (TTI), minimally invasive and better therapeutic effect approaches are being explored to replace the conventional combined lateral and medial approach (CLMA). This study was performed to compare the clinical effect and security of the modified posterior approach (MPA) through the space of the proximal radioulnar joint vs the CLMA for treatment of TTI. Methods This study retrospectively analyzed 76 patients treated for TTI from January 2009 to December 2020 (MPA: n = 44; CLMA: n = 32). Treatment involved plate and screw fixation or Steinmann pin fixation for the radial head and ulnar coronoid process fractures. Surgeons only sutured the lateral ligament because the medial collateral ligament was usually integrated in the TTI. The continuous variables were compared by the independent Student t‐test and the categorical variables by the χ2‐test or Fisher's exact test. Results Both groups of patients attained a satisfactory MEPS after the operation. The MEPS (MPA: 96.82 ± 6.04 vs CLMA: 96.56 ± 5.51) was not significantly different between the two groups (p > 0.05). However, the MPA resulted in better elbow flexion and extension (MPA: 123.98 ± 10.09 vs CLMA: 117.66 ± 8.29), better forearm rotation function (MPA: 173.41 ± 6.81 vs CLMA: 120.00 ± 12.18), and less intraoperative hemoglobin (MPA: 9.34 ± 5.64 vs CLMA: 16.5 ± 8.75) and red cell volume loss (MPA: 3.09 ± 2.20 vs CLMA: 6.70 ± 2.97) (All p < 0.05). Although the CLMA had a shorter surgery time (MPA: 171.73 ± 80.68 vs CLMA: 130.16 ± 71.50) (p < 0.05), it had a higher risk of neurologic damage (MPA: 0 vs CLMA: 4) (p < 0.05). Four patients developed forearm or hand numbness after the CLMA, but no patients developed numbness after the MPA. All 76 patients were followed up for 15 months postoperatively. Conclusion The MPA through the space of the proximal radioulnar joint has more prominent advantages than the CLMA for TTI, including single scar, clear exposure, good fixation, lower risk of neurovascular injury, and better elbow joint motion. It is a safe and effective surgical approach that is worthy of clinical promotion.
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Affiliation(s)
- Dianqing Li
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Deye Song
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jiangdong Ni
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sihuai Tang
- Department of Orthopedics, Hunan Aerospace Hospital, Changsha, China
| | - Zhi Gao
- Department of Orthopedics, Hunan Aerospace Hospital, Changsha, China
| | - Penglin Li
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xudong Liu
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Wenbin Xu
- Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, China
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Du S, Wei L, He B, Fang Z, Zhou E, Ma X, Li J. Dynamic fixation using rigid tape in rehabilitation after surgery of terrible triad injury of the elbow: A randomized trial. J Back Musculoskelet Rehabil 2021; 34:957-964. [PMID: 34092597 DOI: 10.3233/bmr-200279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of the study was to identify the efficacy of dynamic fixation using rigid tape (RT) in rehabilitation after surgery of terrible triad injury of the elbow (TTIE). METHODS Sixty patients who underwent surgery of TTIE were equally randomly divided into RT group and hinged external fixation brace (HEFB) group. Dynamic fixations were applied for 8 weeks. General rehabilitation programs were performed for 3 months, 5 times a week. Follow-up (FU) was at six months. Main outcomes included pain (Visual Analogue Scale, VAS), muscle strength, range of motion (ROM), Elbow Function (Mayo Elbow Performance Index, MEPI), Quality of Life (QOL) (Short Form 36 Questionnaire, SF-36). RESULTS There were significant time x group interactions for pain, ROM, MEPI, SF-36 (all p= 0.000), which demonstrated positive efficacy of both the two interventions. Difference at each time-point (except for baseline) of pain and ROM between the two groups was statistically significant (all p< 0.05). Some differences between the two groups were not statistically significant which at 14d on MEPI (p= 0.108) and at 21d (p= 0.259) and FU (p= 0.402) on QOL. Moreover, the increased muscle strength at each time-point had no statistically significant difference between the two groups (all p> 0.05). CONCLUSIONS Both RT and HEFB could significantly improve the postoperative functional outcomes of the TTIE. However, early rehabilitation intervention could increase pain, which affected the corresponding function (MEPI) and QOL. Note that this kind of impact was short-term and reversible. The muscle strength and ROM were not affected by the increased severe pain, maintaining a trend of improvement. In addition, the subjects in the RT group improved faster and more efficiently and had better results with pain, ROM, MEPI, and QOL compared to the subjects in the HEFB group.
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Affiliation(s)
- Shenxing Du
- Department of Rehabilitation, Dongyang People's Hospital, Dongyang, Zhejiang, China
| | - Lihong Wei
- Department of Orthopedics, Dongyang People's Hospital, Dongyang, Zhejiang, China
| | - Bangjian He
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhen Fang
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Eryuan Zhou
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xiaoxiao Ma
- Department of Rehabilitation, Dongyang People's Hospital, Dongyang, Zhejiang, China
| | - Ju Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Zha YJ, Xiao D, Hua KH, Sun WT, Gong MQ, Li T, Chen C, Jiang XY. Lateral minimal approach to the terrible triad of the elbow: a treatment protocol in Beijing Jishuitan Hospital. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1232. [PMID: 34532369 PMCID: PMC8421974 DOI: 10.21037/atm-21-2542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/01/2021] [Indexed: 12/02/2022]
Abstract
Background This study aimed to report the surgical techniques and results of treating coronoid process and radial head fracture combined with dislocation of the elbow (terrible triad of the elbow) using a single lateral incision, known as the extensor digitorum communis (EDC) split approach. Methods A retrospective analysis was performed of 109 patients with terrible triad of the elbow who had been treated by the authors from January 2013 to December 2019. The participants included 67 males and 42 females, with a mean age of 42.2 years (14–71 years). All participants were treated via a single lateral approach. The coronoid process was fixated with Kirschner wires combined with anterior capsule suture lasso fixation. For the radial head fracture, 58 cases were fixated by AO headless cannulated screw (AO HCS) and 51 cases by acumed radial head replacement. In repair of the lateral collateral ligament (LCL) complex and the common extensor tendon, 28 cases used ETHIBOND suture through bone holes at the humeral lateral epicondyle, and the other 81 cases used suture anchors. No medial collateral ligament was repaired. A total of 46 participants were fixated with a Stryker dynamic joint distractor (DJD) II hinged external fixator to protect the bone and soft tissue. Results All participants were followed up from 6 to 60 months (mean, 36.1 months). Their elbow range of flexion and extension averaged 123.4°±20.7°, forearm rotation 151.0°±25.6°, and Mayo elbow performance score (MEPS) 92.3±8.8. There were 22 participants (19.5%) with ulnar nerve symptoms, 16 (14.7%) who had elbow stiffness, and 7 underwent secondary surgery, including 6 removals of internal fixation, 5 arthrolyses of the elbow, and 2 ulnar neurolyses. Conclusions Coronoid fractures, radial head fractures, and LCL injuries of the terrible triad of the elbow can be treated satisfactorily through a lateral minimal incision, combined with a hinged external fixation if necessary.
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Affiliation(s)
- Ye-Jun Zha
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Dan Xiao
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Ke-Han Hua
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Wei-Tong Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Mao-Qi Gong
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Ting Li
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Chen Chen
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, China
| | - Xie-Yuan Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, China
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Wang F, Jia S, Li M, Pan K, Zhang J, Fan Y. Effect of the medial collateral ligament and the lateral ulnar collateral ligament injury on elbow stability: a finite element analysis. Comput Methods Biomech Biomed Engin 2021; 24:1517-1529. [PMID: 33715549 DOI: 10.1080/10255842.2021.1898601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ligaments are the most important stabilizer of elbow. However, the stress of ligaments is hard to measure because of the complex biomechanical environment in the elbow. Our objective was to develop a human elbow finite element model and to validate it by a comparison with previous experimental data. Then several different ligaments injury conditions and elbow flexion were simulated to analyse the elbow instability and to stress the biomechanical consequences. The computational investigation of different effects of ligament constraints of elbow was studied by means of finite element analysis. The stress of the anterior bundle was almost greater than other ligaments in all conditions, which played the most important role during the elbow flexion. The posterior bundle was the secondary stabilizer during flexion after the anterior bundle. The lateral ulnar collateral ligament (LUCL) injury could result in an increase of the ulnar cartilage stress. The anterior bundle and the LUCL were recommended to be repaired in elbow joint dislocations and fractures. This study could help understand the dynamic effects of ligaments on the joint over the entire extension by investigating the tissue stress.
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Affiliation(s)
- Fang Wang
- College of Mechanical Engineering, Tianjin University of Science & Technology, No. 1038, Dagu Nanlu, Hexi District, Tianjin, China.,Tianjin Key Lab of Integrated Design and On-line Monitoring for Light Industry & Food Machinery and Equipment, Tianjin, China.,National Research Centre for Rehabilitation Technical Aids, No. 1, Ronghuazhonglu, BDA, Beijing, China.,Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, No.1, Ronghuazhonglu, BDA, Beijing, China
| | - Shuoqi Jia
- College of Mechanical Engineering, Tianjin University of Science & Technology, No. 1038, Dagu Nanlu, Hexi District, Tianjin, China
| | - Mingxin Li
- Department of Traumatic Orthopaedics, Tianjin Hospital, No. 406, Jiefang Nanlu, Hexi District, Tianjin, China
| | - Kui Pan
- College of Mechanical Engineering, Tianjin University of Science & Technology, No. 1038, Dagu Nanlu, Hexi District, Tianjin, China
| | - Jianguo Zhang
- College of Mechanical Engineering, Tianjin University of Science & Technology, No. 1038, Dagu Nanlu, Hexi District, Tianjin, China.,Tianjin Key Lab of Integrated Design and On-line Monitoring for Light Industry & Food Machinery and Equipment, Tianjin, China
| | - Yubo Fan
- Beijing Advanced Innovation Centre for Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Chinese Education Ministry, School of Biological Science and Medical Engineering, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, China.,School of Engineering Medicine, Beihang University, No.37, Xueyuan Road, Haidian District, Beijing, China
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Wang J. The serious full-length forearm injury - a case report and literature review. BMC Musculoskelet Disord 2020; 21:381. [PMID: 32539757 PMCID: PMC7296690 DOI: 10.1186/s12891-020-03394-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/02/2020] [Indexed: 11/26/2022] Open
Abstract
Background Among upper limb injuries, carpal bone fractures and dislocation, Essex-Lopresti injury, and the terrible triad injury of the elbow are serious and relatively rare injuries. These injuries require surgical intervention. The surgical method is difficult, and the treatment effect is poor. These injuries have not been described in the same limb in the literature. Case presentation A 21-year-old male patient fell from a height in our institution and sustained multiple injuries, including carpal bone fracture-dislocation, Essex-Lopresti injury, and the terrible triad injury of the elbow of his right upper limb. After 2 surgeries and rehabilitation, he returned to work. We reviewed available reviews and related literature on serious upper-limb damage. Conclusions Full-length forearm injury is very rarely encountered, and the management of such fractures is difficult. Radial head replacement with a metal prosthesis, reconstructed the IOM with Tightrope, and fixed the DRUJ with a K-wire pin is appropriate treatment.
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Affiliation(s)
- Jun Wang
- Department of orthopedic, Xiaoshan 1st People's Hospital, Hangzhou, 311200, China. .,Department of orthopedic, Xiaoshan 1st People's Hospital, No. 199 Shixin Road, Hangzhou, 311201, Zhejiang Province, China.
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Jiménez-Martín A, Contreras-Joya M, Navarro-Martínez S, Najarro-Cid F, Santos-Yubero F, Pérez-Hidalgo S. Clinical results of radial arthroplasty in Hotchkiss' terrible triad, a case series of 47. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Resultados clínicos de la artroplastia radial en la tríada terrible de Hotchkiss, a propósito de 47 casos. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:83-91. [DOI: 10.1016/j.recot.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 09/29/2019] [Accepted: 11/11/2019] [Indexed: 11/20/2022] Open
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Meena MK, Singh K, Meena S, Kumbhare C, Chouhan D. Lateral Approach Versus Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis. Bull Emerg Trauma 2020; 8:4-9. [PMID: 32201696 PMCID: PMC7071937 DOI: 10.29252/beat-080102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective To find out which surgical approach, optimize the functional outcomes and reduce the risk of complications in terrible triad of elbow". Methods Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had terrible triad of elbow (TTIE) that compared lateral approach (LA) with combined lateral and anteromedial approach (CML), and were published in English. Outcomes of interest were functional outcomes, complications, and operative time. Results Four studies, involving 470 patients were included in the systematic review. Mean follow up after surgery was typically 24 to 30 months. We found significant more range of motion (ROM) of elbow in CML as compared to LA group (MD: -14.21, 95% CI: -21.13 to-7.29, p<0.00001). There was significant more forearm rotation in CML as compared to LA group (MD: -18.88, 95% CI: -32.35 to -5.40, p<0.00001). Mayo elbow performance score (MEPS) was significantly more in CML (MD: -3.31, 95% CI: -7.23 to 0.62, p=0.00001). Blood loss, operative time, VAS and complications were more in CML group; however, the difference was not significant. The heterogeneity of the study and synthesizing retrospective data were the primary limitations. Conclusion Our analysis demonstrated that combined lateral and medial approach had significantly more elbow ROM and forearm rotation. The combined approach also had significantly more MEPS. However, using combined approach significantly increased the operative time.
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Affiliation(s)
- Mukesh Kumar Meena
- Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India
| | - Karmbeer Singh
- Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India
| | - Sanjay Meena
- Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India
| | - Chetan Kumbhare
- Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India
| | - Dushyant Chouhan
- Department of Orthopedics, Lady Hardinge Medical College(LHMC) and Associated Hospitals, New Delhi, India
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Abstract
BACKGROUND Surgical treatment for terrible triad injuries remains a challenging clinical problem, and controversy exists of whether it is better to repair or replace the radial head. The objective of this systematic review was to evaluate the clinical outcomes of repair and arthroplasty replacement of the radial head in patients with terrible triad injury. METHODS Medline, Cochrane Library, EMBASE, and Google Scholar were searched up to July 30, 2018 to identify the relevant studies, which included patients who had received treatments of the terrible triad of the elbow and also had reported with the quantitative outcomes. Outcomes of interest were functional outcomes. RESULTS Four studies with a total of 115 patients were included in the systematic review. Most patients were type II or III radial head fractures based on the Mason classification systems. Fifty-one patients received radial head repair surgery and 64 underwent replacement. Two studies had indicated that patients in the replacement group were significantly associated with better treatment outcome assessed by DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. The meta-analysis indicated that patients with the arthroplasty replacement were associated with significantly better ROM outcomes in flexion, extension, pronation than those with radial head repaired. In addition, patients in the replacement group showed fewer post-surgery complications than those in the repair group. CONCLUSIONS Our review had indicated that patients with terrible triad injuries undergo arthroplasty replacement have better clinical outcomes and fewer post-surgery complications than those received the repair surgery. Radial head replacement might be a more effective treatment approach with good clinical outcomes for patients with a terrible triad of the elbow.
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Affiliation(s)
- Hongwei Chen
- Department of Orthopedics, Yiwu Central Hospital, Affiliated Hospital of Wenzhou Medical University, Yiwu, Zhejiang Province
| | - Yinchu Shao
- The 94th Hospital of PLA, Nanchang, 330002, Jiangxi
| | - Shaobo Li
- Department of Surgery, College of Clinical Medicine, Dali University, Dali 671000,Yunnan Province, China
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Chen HW, Huang SM. Risk factors of efficacy for patients receiving surgical treatment following terrible triad of the elbow joint: A comparative study. Medicine (Baltimore) 2019; 98:e13836. [PMID: 30608399 PMCID: PMC6344182 DOI: 10.1097/md.0000000000013836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aims to explore the efficacy of surgical and conservative treatment for elbow joint terrible triad, and evaluate related factors affecting surgical treatment efficacy. METHODS Patients with terrible triad of elbow joint (n = 165) were selected, among which 79 cases underwent conservative treatment (the control group) and 86 cases underwent surgical treatment (the experimental group). The range of flexion and extension, range of rotation and Mayo elbow performance score were recorded. In the experimental group, postoperation, according to the Mayo elbow performance score, patients were assigned into the effective group (72 cases) and ineffective group (14 cases). All patients were followed up regularly for 6 to 24 months. X-ray and computed tomography examination were used to examine anterior and posterior elbow joints preoperatively and postoperatively and the degree of arm rotation. RESULTS The range of flexion and extension, range of rotation and Mayo elbow performance score were found to be significantly higher in the experimental group after treatment compared to the experimental group before treatment and in the control group after treatment. Seven days after treatment, compared with the control group, the expressions of interleukin (IL)-6, C-reactive protein, IL-8, and tumor necrosis factor-α in serum decreased, and returned to almost near normal levels in the experimental group. Age, mean operative time, and postoperative immobilization time were significantly different between the effective and ineffective groups. The incidence of joint stiffness, heterotopic ossification, and ulnar nerve symptoms in the effective group were lower than those in the ineffective group. The postoperative immobilization time served a protective factor for the efficacy of surgical treatment of elbow joint terrible triad, while age served as a risk factor. CONCLUSION The results indicated that surgical treatment regimens for elbow joint terrible triad exhibited better efficacy than conservative treatment regimens, and lower age and longer postoperative immobilization time serve as protective factors for surgical treatment efficacy.
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Affiliation(s)
- Hong-Wei Chen
- Department of Orthopedic Surgery, Yiwu Central Hospital, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu
| | - Shu-Ming Huang
- Department of Orthopedics, Lishui Municipal Central Hospital, Lishui Hospital of Zhejiang University, The 5th Affiliated Hospital of Wenzhou Medical University, Lishui, China
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Rooke GMJ, Maarschalk JA, Navarre P. Pediatric Terrible Triad Injury of the Elbow: A Rare and Easily Missed Injury: A Case Report. JBJS Case Connect 2018; 8:e106. [PMID: 30601276 DOI: 10.2106/jbjs.cc.18.00114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CASE We report the case of a pediatric terrible triad injury of the elbow consisting of an ulnohumeral dislocation, a radial neck fracture, and a coronoid chondral injury, which was diagnosed at 14 days following injury. We describe our surgical technique and provide details of the postoperative course, including the development of a rotational contracture following heterotopic ossification. CONCLUSION We describe a rare and challenging injury that should be recognized early and managed surgically to maintain acceptable elbow function.
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Affiliation(s)
- Gareth M J Rooke
- Department of Orthopaedics, Wellington Regional Hospital, Wellington, New Zealand
| | | | - Pierre Navarre
- Department of Orthopaedics, Southland Hospital/University of Otago, Invercargill, New Zealand
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Gottlieb M, Schiebout J. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med 2018; 54:849-854. [DOI: 10.1016/j.jemermed.2018.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/04/2018] [Accepted: 02/07/2018] [Indexed: 01/13/2023]
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IKEMOTO ROBERTOYUKIO, MURACHOVSKY JOEL, BUENO ROGÉRIOSERPONE, NASCIMENTO LUISGUSTAVOPRATA, CARMARGO ADRIANOBORDINI, CORRÊA VITORELIAS. TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT. ACTA ORTOPEDICA BRASILEIRA 2017; 25:283-286. [PMID: 29375261 PMCID: PMC5782865 DOI: 10.1590/1413-785220172506168821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the functional and radiographic results of patients who underwent surgical treatment for terrible triad-type elbow injuries (TTE). METHODS We retrospectively evaluated 20 patients, including one case with bilateral injuries (total of 21 elbows) that were surgically treated from January 2004 to July 2014. We evaluated the functional results of treatment by measuring the restored range of motion (ROM) of the elbow, using the DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. Complications and the development of osteoarthritis and heterotopic ossification (HO) were also evaluated. RESULTS Eight elbows (38%) required additional surgical treatment; HO was observed in eight elbows (38%) and severe osteoarthritis (Broberg-Morrey type IV) was seen in only one case (4%). Nevertheless, we obtained good functional results, 14.27 on the DASH and 84 on the MEPS. The average ROM for flexion-extension was 101° (20-140°) and for pronation-supination was 112.85° (0-180°). CONCLUSION When TTE injuries are treated systematically, even despite variations in these injuries, functional ROM and scores ranging from good to excellent can be obtained. Level of Evidence IV, Case Series.
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Chen HW, Wang ZY, Wu X, Tang B, Zhu W, Zhou G, Liu F, Qiu B. Evaluation of a combined posterior lateral and anteromedial approach in the treatment of terrible triad of the elbow: A retrospective study. Medicine (Baltimore) 2017; 96:e6819. [PMID: 28562532 PMCID: PMC5459697 DOI: 10.1097/md.0000000000006819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This retrospective study aims to investigate the efficacy and safety of a combined posterior lateral and anteromedial approach in the treatment of terrible triad of the elbow (TTE). METHODS TTE patients who received a combination of posterior lateral and anteromedial approach or other conservative treatments were included in the present study. The postoperative functions of the elbow and the severity of traumatic arthritis were assessed using the Mayo Elbow Performance Score (MEPS) and visual analog scale (VAS). Extension-flexion of elbow joint and rotation of forearm were also measured. RESULTS A combined posterior lateral and anteromedial approach or other conservative treatments showed significant improvements in the activity of the elbow, MEPS, VAS, the excellent rate, and x-ray results. The postoperative healing time and complication rate of patients who received a combined posterior lateral and anteromedial approach significantly decreased compared to those who received other conservative treatments. CONCLUSIONS Patients with TTE who received a combined posterior lateral and anteromedial treatment had an increased fracture healing rate, showed improved recovery of elbow functions and had fewer complications.
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Chen HW, Wang ZY, Wei GS. Evaluation of the therapeutic effects of lateral approach combined with anteromedial approach in the treatment of terrible triad of the elbow. Biomed Pharmacother 2017; 91:748-754. [PMID: 28499246 DOI: 10.1016/j.biopha.2017.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the therapeutic effects of the lateral approach combined with anteromedial approach in the treatment of terrible triad of the elbow. METHODS Between June 2010 and January 2015, 334 patients suffering from terrible triad of the elbow, amongst whom 105 cases underwent lateral approaches combined with anteromedial approaches, 112 cases underwent lateral approaches, and 117 cases underwent anteromedial approaches were included in the study. The serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) were detected using enzyme-linked immunosorbent assay (ELISA) before operation and at 7 days and 3 months after operation. X-ray imaging was employed to examine the recovery condition of the elbow, and the joint motion and the forearm rotation of elbow were evaluated before and after the operation. RESULTS Excellent rate was obtained in accordance with the Mayo Elbow Performance Score (MEPS). The serum levels of CRP, IL-6, IL-8 and TNF-α gradually decreased to normal levels after the operation, and recovery was faster in patients undergoing lateral approach combined with anteromedial approach in comparison to those undergoing lateral and anteromedial approaches. The X-ray images showed good recovery of elbows in all patients, but the range of joint motion, forearm rotation degree, and MEPS were higher in patients undergoing lateral approach combined with anteromedial approach compared to those undergoing lateral and anteromedial approaches independently. CONCLUSION Taken together, these findings demonstrate lateral approach combined with anteromedial approach reveals better therapeutic effect than lateral approach and anteromedial approach in the treatment of terrible triad of the elbow.
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Affiliation(s)
- Hong-Wei Chen
- Department of Orthopedics, Yiwu Hospital of Wenzhou Medical University, Yiwu 322000, PR China.
| | - Zi-Yang Wang
- Department of Orthopedics, Yiwu Hospital of Wenzhou Medical University, Yiwu 322000, PR China
| | - Geng-Sheng Wei
- Department of Orthopedics, Beijing Haidian Section of Peking University Third Hospital, Beijing 100080, PR China
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Perioperative Glucocorticoid Administration Improves Elbow Motion in Terrible Triad Injuries. J Hand Surg Am 2017; 42:41-46. [PMID: 28052827 DOI: 10.1016/j.jhsa.2016.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/20/2016] [Accepted: 11/07/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Among patients who undergo surgical treatment of terrible triad elbow injuries (TTEI), we hypothesized that those who received perioperative glucocorticoid (GC) therapy would have improved postoperative pain and range of motion (ROM) and a similar complication rate compared with patients who did not receive GC therapy. METHODS We retrospectively identified 26 patients who underwent surgical treatment of TTEI from 2009 to 2015. Thirteen patients received a single intraoperative dose of 10 mg intravenous dexamethasone followed with a 6-day oral methylprednisolone taper course (GC group), and 13 did not (control group). After surgery, patients were placed in an orthosis at 90° flexion with the forearm in pronation for 2 weeks, after which ROM was initiated. Patients were seen in clinic at 2, 6, 12, and 24 weeks after surgery, at which time numeric pain scale scores and ROM data were collected and any complications were noted. RESULTS Compared with the control group, the GC group had a greater flexion-extension arc of motion at 24 weeks (132.5° vs 105.5°); significant differences were not found at earlier time points. Supination measurements were significantly greater for the GC group at every time point with a difference at final follow-up of 23.2° (61.0° vs. 84.2°). There were 5 complications in the control group (35.8%), 3 of which required additional surgery, and 3 complications in the GC group (23.1%), 1 of which required another surgery. No postoperative infections were found in either group. CONCLUSIONS Perioperative glucocorticoid administration is associated with improved ROM after surgical treatment of TTEI. Flexion-extension, pronosupination arc of motion, and overall supination were significantly improved. Postoperative pain scores and complication rates were similar between GC and control groups. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Chen HW, Bi Q. Surgical Outcomes and Complications in Treatment of Terrible Triad of the Elbow: Comparisons of 3 Surgical Approaches. Med Sci Monit 2016; 22:4354-4362. [PMID: 27841255 PMCID: PMC5111572 DOI: 10.12659/msm.897297] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study compared the efficacy of combined lateral and medial approach, lateral approach, and anterior medial approach in treatment of terrible triad of the elbow (TTE). MATERIAL AND METHODS Thirty-eight TTE patients hospitalized in our center were retrospectively analyzed, among which 14 patients were arranged for combined lateral and medial approach, 12 for lateral approach, and 12 for anterior medial approach. All included patients underwent open reduction, collateral ligament repair, and postoperative function exercise. Follow-up was conducted for 13~22 months. The elbow motion, excellent and good rate, healing time, and complication rate were recorded and compared. RESULTS These 3 approaches significantly improved the postoperative elbow motion, MEPS, VAS, excellent and good rate, and open reduction (all P<0.05). The VAS score for lateral approach was evidently higher than that for combined lateral and medial approach (P<0.05). Combined lateral and medial approach and anterior medial approach had better performance on elbow motion, MEPS, and excellent and good rate than lateral approach (both P<0.05). Lateral approach and anterior medial approach had a significantly reduced healing time compared with combined lateral and medial approach (both P<0.05), while anterior medial approach had a higher complication rate compared with anterior medial approach and lateral approach (both P<0.05). CONCLUSIONS Lateral combined medial surgery approach contributes to wide surgical exposure, facture stability, and decreased complication rate, and thus has superior efficacy than the other 2 surgical approaches.
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Affiliation(s)
- Hong-Wei Chen
- Department of Orthopedic Surgery, Yiwu Central Hospital, Affiliated Hospital of Wenzhou Medical University, Yiwu, Zhejiang, China (mainland)
| | - Qing Bi
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China (mainland)
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Xiao K, Zhang J, Li T, Dong YL, Weng XS. Anatomy, definition, and treatment of the "terrible triad of the elbow" and contemplation of the rationality of this designation. Orthop Surg 2015; 7:13-8. [PMID: 25708030 DOI: 10.1111/os.12149] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/05/2014] [Indexed: 12/01/2022] Open
Abstract
In the realm of orthopaedics, the terrible triad of the elbow is infamous, not simply because the prognosis is poor for most patients, but also, maybe to a greater extent, because the unique name of this malady attracts considerable attention and interest in both doctors and patients. The adjective terrible is bestowed on an elbow triad that comprises three coexisting complicated traumas; namely, radial head and ulnar coronoid process fractures and posterior dislocation of the elbow joint. In this review, the classification, treatment principles and prognosis for different forms of management of the radial head and ulnar coronoid process fractures and the ligaments lesions are introduced sequentially and various surgical procedures and their efficacy are discussed. This triad has long given orthopedic surgeons headaches. Nonetheless, in recent years a series of anatomical mechanical studies on the elbow joint have been published and there have been several breakthroughs in surgical techniques for managing this elbow triad. This review examines some memorable millstones and unveils trends in the current clinical norm for this triad. The accomplishments achieved recently have reportedly resulted in enhanced prognoses in the last two or three years compared with previous years. It is therefore high time to revise our thoughts about the justice and accuracy of defining this triad of the elbow as terrible. Lastly, we may safely conclude that the terrible triad of the elbow is much less terrible than previously, provided the commonly approved clinical approaches are undertaken.
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Affiliation(s)
- Ke Xiao
- Orthopaedic Department of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Goldflam K. Evaluation and Treatment of the Elbow and Forearm Injuries in the Emergency Department. Emerg Med Clin North Am 2015; 33:409-21. [PMID: 25892729 DOI: 10.1016/j.emc.2014.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Katja Goldflam
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue, New Haven, CT 06511, USA.
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Brigato RM, Mouraria GG, Kikuta FK, Coelho SDP, Cruz MA, Zoppi A. Functional evaluation of patients with surgically treated terrible triad of the elbow. ACTA ORTOPEDICA BRASILEIRA 2015; 23:138-41. [PMID: 26207090 PMCID: PMC4503605 DOI: 10.1590/1413-78522015230301008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 09/24/2014] [Indexed: 05/17/2024]
Abstract
OBJECTIVES To evaluate the functional outcome of patients with surgically treated terrible triad of the elbow. METHODS A retrospective evaluation was performed using the MEPS score (Mayo Elbow Performance Score) of patients diagnosed with terrible triad of the elbow who underwent surgical treatment. RESULTS 14 patients (nine men and five women) and 15 elbows (one bilateral case) were evaluated. A MEPS average score of 78 points and 86% good and excellent results was obtained. As complications, we had one case of infection and three of neuropraxia of the ulnar nerve. CONCLUSION The patients had stable elbow with good function, however with reduced range of motion. Level of Evidence IV, Case Series.
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Affiliation(s)
- Rafael Mulatti Brigato
- Department of Orthopedics and Traumatology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Guilherme Grisi Mouraria
- Department of Orthopedics and Traumatology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Fernando Kenji Kikuta
- Department of Orthopedics and Traumatology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Sérgio de Paula Coelho
- Department of Orthopedics and Traumatology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Márcio Alves Cruz
- Department of Orthopedics and Traumatology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
| | - Américo Zoppi
- Department of Orthopedics and Traumatology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil
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Operative Treatment of Terrible Triad of the Elbow via Posterolateral and Anteromedial Approaches. PLoS One 2015; 10:e0124821. [PMID: 25910196 PMCID: PMC4409296 DOI: 10.1371/journal.pone.0124821] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 03/18/2015] [Indexed: 11/20/2022] Open
Abstract
The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow. The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. The mechanism of injury included fall from height in 9 patients and traffic accident in 3. According to O’Driscoll classification for fractures of the ulnar coronoid, there were 11 patients with type Ⅰ and 1 with type Ⅱ fractures. According to Mason classification for fractures of the radial head, there were 3 patients with type Ⅰ, 7 with type Ⅱ and 2 with type Ⅲ fractures. All patients were followed up for 12-27 months (average 15.5 months), which showed no pain or severe pain in all patients except for 2 patients with mild pain. At the last follow-up, the mean flexion was for 125°(range, 90°-140°), the mean extension loss for 20°(range, 0°-70°), the mean pronation for 66°(range, 20°-85°) and the mean supination for 60°(range, 30°-85°). The bony union time was 8-14 weeks (average 11 weeks) and the elbows were stable in flexion-extension and varus-valgus in all patients. The elbows maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation. Mild heterotopic ossification of the elbow occurred in 3 patients at 6 months after operation and mild degenerative change in 1 patient at 18 months after operation. The Broberg and Morrey elbow performance score was 82 points (range, 58-98 points). The results were excellent in 6 patients, good in 4, fair in 1 and poor in 1, with excellence rate of 83.3%. The results showed that the combined posterolateral and anteromedial approaches can facilitate the reduction and fixation of terrible triad of the elbow. Repair of radial head, coronoid, medial and lateral collateral ligaments can sufficiently restore the elbow stability, allow early postoperative motion and enhance the functional recovery.
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Gajendran VK, Bishop JA. Terrible triad elbow fracture-dislocation with triceps and flexor-pronator mass avulsion. Orthopedics 2015; 38:e143-6. [PMID: 25665121 DOI: 10.3928/01477447-20150204-91] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 06/24/2014] [Indexed: 02/03/2023]
Abstract
Terrible triad elbow injuries, consisting of fractures of the radial head and coronoid with ulnohumeral dislocation, are challenging to treat. They require a comprehensive understanding of the complex anatomy of the elbow to effectively treat all of the pathology and create a stable, congruent joint. The authors present a case of a terrible triad injury with avulsion of the triceps and flexor-pronator mass after a low-energy fall in a young patient. Although most terrible triad fracture-dislocations can be successfully treated with coronoid fixation, radial head fixation or replacement, and repair of the lateral collateral ligament complex, this case involved a completely circumferential injury to the elbow. The coronoid and anterior capsule were disrupted anteriorly, the radial head and lateral collateral ligament complex were disrupted laterally, the triceps was disrupted posteriorly, and the flexor-pronator mass was disrupted medially. Although the authors prefer to address most terrible triad injuries through a lateral approach, they suspected a circumferential injury preoperatively and elected to use a single posterior incision to address all of the pathology conveniently. This injury required treatment of all disrupted structures, because the elbow remained unstable until the triceps and flexor-pronator mass avulsions were ultimately repaired. With any elbow fracture-dislocation, surgeons should look for evidence of additional injuries that do not fit the commonly described patterns, because they may necessitate modifications to the treatment plan. Given the relatively common complications of stiffness and instability despite modern surgical techniques, additional injuries may further compromise functional outcomes unless they are addressed properly.
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Kılıç TY, Unek O, Yesilaras M, Toker I. Terrible triad of elbow. Emerg Med J 2014; 31:913. [PMID: 24938276 DOI: 10.1136/emermed-2014-203920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Turgay Yılmaz Kılıç
- Department of Emergency Medicine, Izmir Tepecik Research and Educational Hospital, Izmir, Turkey
| | - Orkun Unek
- Department of Emergency Medicine, Izmir Tepecik Research and Educational Hospital, Izmir, Turkey
| | - Murat Yesilaras
- Department of Emergency Medicine, Izmir Tepecik Research and Educational Hospital, Izmir, Turkey
| | - Ibrahim Toker
- Department of Emergency Medicine, Izmir Tepecik Research and Educational Hospital, Izmir, Turkey
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Complications of treating terrible triad injury of the elbow: a systematic review. PLoS One 2014; 9:e97476. [PMID: 24832627 PMCID: PMC4022574 DOI: 10.1371/journal.pone.0097476] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/19/2014] [Indexed: 11/22/2022] Open
Abstract
Objective Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications following surgical management of TTIE. Methods Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had TTIE, and were published in English. Outcomes of interest were functional outcomes and complications. Results Sixteen studies, involving 312 patients, were included in the systematic review. Mean follow up after surgery was typically 25 to 30 months. Mean Mayo elbow performance scores ranged from 78 to 95. Mean Broberg-Morrey scores ranged from 76 to 90. Mean DASH scores ranged from 9 to 31. The proportion of patients who required reoperation due to complications ranged from 0 to 54.5% (overall = 70/312 [22.4%]). Most of these complications were related to hardware fixation problems, joint stiffness, joint instability, and ulnar neuropathy. The most common complications that did not require reoperation were heterotopic ossification (39/312 [12.5%] patients) and arthrosis (35/312 [11.2%] patients). Conclusions The results of this systematic review indicate that functional outcomes after surgery for TTIE are generally satisfactory and that complications are common. Further research is warranted to determine which surgical techniques optimize functional outcomes and reduce the risk of complications.
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Sormaala MJ, Sormaala A, Mattila VM, Koskinen SK. MDCT findings after elbow dislocation: a retrospective study of 140 patients. Skeletal Radiol 2014; 43:507-12. [PMID: 24453027 DOI: 10.1007/s00256-014-1819-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 12/30/2013] [Accepted: 01/06/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the number and anatomical location of fractures associated with elbow dislocation, to study the correlation between the direction of dislocation and the trauma energy, and to assess radiographs' diagnostic performance characteristics for fractures using MDCT as a reference standard. MATERIALS AND METHODS A retrospective study was performed at a level 1 trauma center, finding a total of 140 patients who had sustained an elbow dislocation and who had undergone a subsequent MDCT examination. The CT and radiographs of the patient were reviewed by two musculoskeletal radiologists. CT images were analyzed for the site and size of the fracture fragments. In addition, the primary direction of the dislocation, patients' age, and gender were recorded. Trauma energy was also assessed. RESULTS One hundred and thirty-four out of 140 patients (96%) had a fracture that was seen on the correlative CT examination. The most common anatomical fracture locations were the coronoid process of the ulna 84 out of 140 (60%), the radial head 75 out of 140 (54%), and the humeral capitellum 57 out of 140 (41%). Multiple fractures were seen in 71 out of 134 (53%) patients with fractures. The left elbow was more commonly dislocated than the right one. The overall sensitivity of the radiographs was 62% and the specificity 96%. CONCLUSION Small fractures and impaction fractures are almost invariably present in elbow dislocations, and half of the patients have more than one fracture. Radiographs have a sensitivity of only 62%. MDCT is an invaluable method for determining the extent of bony injury and revealing occult fractures.
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Affiliation(s)
- Markus J Sormaala
- Medical Imaging Center, Helsinki University Central Hospital, Helsinki, Finland,
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