Surgical Approach to Posterior Dislocation of the Elbow Combined with Radial Head and Coronoid Fractures (Terrible Triad): Report of 19 Cases

Background: Terrible triad injury of the elbow has been a real challenge for surgeons. New standard methods of treatment have significantly improved outcomes, but yet complications occur frequently and rate of reoperation is still noticeable. Methods: The outcomes of lateral surgical approach in 19 patients with terrible triad injury were evaluated through Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results: A concentric congruency was achieved for 18 cases. The average of MEPS was 87.11±12.05. Therefore, 17 patients had excellent and good and two fair and poor results . Average of DASH score was 17±13.83. Due to early postoperative dislocation joint stiffness occurred in one patient. Conclusion: In our experience, lateral approach provides an adequate view to access and reconstruct all stabilizing elements and could be considered as an acceptable option in terrible triad injury treatment. Keywor ds : Complication, Elbow, Lateral approach, Terrible triad.

[1]  M. Yeşilaras,et al.  Terrible triad of elbow , 2014, Emergency Medicine Journal.

[2]  J. Owen,et al.  Complex varus elbow instability: a terrible triad model. , 2009, Journal of shoulder and elbow surgery.

[3]  B. Morrey,et al.  Complications of hinged external fixators of the elbow. , 2008, Journal of shoulder and elbow surgery.

[4]  J. Jupiter,et al.  The pathoanatomy of elbow fracture-dislocations: A road map to treatment , 2008 .

[5]  Á. Hernández,et al.  Terrible Triad of the Elbow—Role of the Coronoid Process: A Case Report , 2005, Journal of orthopaedic surgery.

[6]  M. McKee,et al.  Posterolateral rotatory instability of the elbow following radial head resection. , 2005, The Journal of bone and joint surgery. American volume.

[7]  M. McKee,et al.  Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. , 2005, The Journal of bone and joint surgery. American volume.

[8]  Minoo Patel,et al.  Management of unstable elbows following complex fracture-dislocations--the "terrible triad" injury. , 2004, The Journal of bone and joint surgery. American volume.

[9]  D. Ring,et al.  Posterior Dislocation of the Elbow with Fractures of the Radial Head and Coronoid , 2002, The Journal of bone and joint surgery. American volume.

[10]  B F Morrey,et al.  The unstable elbow: An evidence-based approach to evaluation and management , 2017 .

[11]  D. Hanel,et al.  The elbow , 2000 .

[12]  U. Heim.  [Combined fractures of the radius and the ulna at the elbow level in the adult. Analysis of 120 cases after more than 1 year]. , 1998, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur.

[13]  K. An,et al.  Elbow subluxation and dislocation. A spectrum of instability. , 1992, Clinical orthopaedics and related research.

[14]  B F Morrey,et al.  Valgus stability of the elbow. A definition of primary and secondary constraints. , 1991, Clinical orthopaedics and related research.

[15]  B. Morrey,et al.  Fractures of the coronoid process of the ulna , 1989, The Journal of bone and joint surgery. American volume.

[16]  O. Johnell,et al.  Dislocations of the elbow and intraarticular fractures. , 1989, Clinical orthopaedics and related research.

[17]  O. Johnell,et al.  Ligamentous injuries in dislocations of the elbow joint. , 1987, Clinical orthopaedics and related research.

[18]  B. Morrey,et al.  Results of treatment of fracture-dislocations of the elbow. , 1987, Clinical orthopaedics and related research.

[19]  A A HALLS,et al.  Transmission of pressures across the elbow joint , 1964, The Anatomical record.

[20]  G. Johnston.  A Follow-up of One Hundred Cases of Fracture of the Head of the Radius with a Review of the Literature , 1962, The Ulster medical journal.

[21]  Johnston Gw.  A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. , 1962 .

[22]  K. Koval,et al.  Fracture-dislocation of the elbow functional outcome following treatment with a standardized protocol. , 2007, Bulletin of the NYU hospital for joint diseases.

[23]  A. Weiland,et al.  Valgus stability of the elbow , 1987, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.