Schwab GH, Bennett JB, Woods GW, Tullos HS. The coronoid can be repaired using sutures, anchors or screws depending on the size of the fragment and exposure. These had a concentric reduction with stability beyond 30 degrees of extension after closed reduction. This is where the MCL is least effective. van Riet RP, Morrey BF, O’Driscoll SW. Use of osteochondral bone graft in coronoid fractures. The Open Orthopaedics Journal is committed to ensuring high quality of research published. A spectrum of instability.  |  Hu X, Xiang M, Chen H, Yang S, Tang H, Yang G. Operative treatment of anterior olecranon fracture-dislocation. Chan K, MacDermid JC, Faber KJ, King GJ, Athwal GS. These are high energy injuries often caused by road traffic collisions [51, 52] and are associated with concomitant ipsilateral elbow injuries, such as segmental fracture in over 80% [53]. Articles are of uniformly high quality and written by the world's leading authorities. When used it should be followed by early mobilisation which is most effective at 30-120 degrees of active extension [54]. Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head. An axial load to the elbow in extension and a varus stress will cause compression injury to the medial side of the elbow giving rise to coronoid fractures, and tension forces acting laterally causing LCL rupture [14]. Fracture of the anteromedial facet of the coronoid process. The terrible triad of the elbow is a difficult injury with historically poor outcomes. J Bone Joint Surg Am 2011; 93(20): 1873-81. Wake H, Hashizume H, Nishida K, Inoue H, Nagayama N. Biomechanical analysis of the mechanism of elbow fracture-dislocations by compression force.  |  Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. A variant of the posterior dislocation has been described with biepicondylar humeral fracture in a seventeen year old male patient [63], and also with radial shaft fracture and radial head dislocation [64]. Better long term results are seen in displaced or comminuted type III fractures treated with radial head replacement rather than excision when there is instability as seen with fracture dislocations [21, 22]. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor. Instr Course Lect. Morrey BF, Askew LJ, Chao EY. Chen HW, Liu GD, Wu LJ. This highlights the need of the surgeon to thoroughly assess the patient with routine examination of structures around the elbow that are not usually associated with complex dislocation. A fall from a ladder sends a 65-year-old male patient to the emergency department with left elbow pain. Offer advice on journals’ policy and scope. The articles published in the open access journals are high quality and cover a wide range of fields. The combination of elbow dislocation with both radial head and coronoid process fracture is notoriously challenging to treat and, as such, has been termed ‘‘terrible triad’’ injury of the elbow (TTIE) [1]. Open Orthop J 2010; 4: 80-6. These injuries can be categorised into groups according to their mechanism and the structures injured. Josefsson PO, Gentz CF, Johnell O, Wendeberg B. Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint. J Bone Joint Surg Am 2002; 84-A(4): 547-51. For this reason, it has been called the “terrible triad injury” of the elbow [3] Terrible triad injuries can lead to pain, recurrent instability, sti ness, and posttraumatic arthritis if not properly treated [6]. Lindenhovius AL, Jupiter JB, Ring D. Comparison of acute versus subacute treatment of terrible triad injuries of the elbow. Surgical treatment of terrible triad injuries carries a high complication rate with an average of 22% reoperation rate [39]. Bucholz, J.D. CT scan of the elbow should be performed to assess the suitability of radial and coronoid fractures for repair or replacement [29] (Figs. Peer-review of articles for the journal, which are in the area of expertise (2 to 3 times per year). Email subject: Editorial Board Member Application, "Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines. Terrible triad of the elbow: a case report of a new variant. These findings stress the importance of obtaining CT scans after initial reduction to assess the size and type of coronoid fracture. (3). Clin Orthop Relat Res 2004; (429): 292-300. Other patterns of injury may exist and case reports reflect the multitude of ways in which forces can disrupt the elbow joint. Forthman C, Henket M, Ring DC. A prospective randomized study. Abstract Fracture-dislocations of the elbow remain among the most difficult injuries to manage. Loss of these stabilisers causes subluxation or dislocation and arthrosis if left untreated [45]. J Shoulder Elbow Surg 2012; 21(10): 1336-41. doi: 10.3928/01477447-20150204-91. Submit or solicit at least one article for the journal annually. Whichever algorithm is followed the aim of surgery is the same: to achieve an outcome where the joint is stable and has a pain free functional range of motion. Introduction. Olecranon fractures: Treatment options. Ring D, Jupiter JB. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2013; 27(2): 151-4. 1962 Jun 1;31:51-6 Terrible triad of the elbow and the Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome. The origins of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) complexes avulse from the epicondyles and the anterior capsule fails with a transverse fracture of the coronoid tip. Toros T, Ozaksar K, Sügün TS, Kayalar M, Bal E, Ada S. The effect of medial side repair in terrible triad injury of the elbow. J Shoulder Elbow Surg 2005; 14(5): 519-23. Wilkerson RD. The elbow and its disorders. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. Ring D. Displaced, unstable fractures of the radial head: Fixation. 4 and 5). Prolonged immobilization in plaster for longer than 4 weeks is detrimental [18]. Pollock JW, Brownhill J, Ferreira L, McDonald CP, Johnson J, King G. The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics. Clin Orthop Relat Res 2014; 472(7): 2084-91. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. Fracture-dislocations of the elbow remain among the most difficult injuries to manage. How should anteromedial coronoid facet fracture be managed? 2011 Dec;15(4):198-208. doi: 10.1097/BTH.0b013e31822911fd. Ring D, Doornberg JN. Elbow extension with forearm supination and added valgus stress puts most strain on the ulnohumeral joint, radial head and MCL respectively, causing a posterolateral rotational instability pattern of fracture-dislocation which includes posterior dislocation with a radial head fracture and the terrible triad injury with an added coronoid fracture. A direct blow to the flexed elbow can cause an anterior displacement of the ulna with resulting olecranon fracture. Anterior dislocation with olecranon fracture has the same treatment aims as other complex dislocations with the added need to restore the extensor mechanism. Good outcomes were achieved with LCL repair only for Subgroup 1 fractures, and AMCF fixation and LCL repair for subgroup II and III Injuries. Pipicelli JG, Chinchalkar SJ, Grewal R, Athwal GS. The “terrible triad” injury is classically described as a combination of a coronoid process and radial head fractures, as well as a posterolateral elbow dislocation. Lindenhovius AL, Brouwer KM, Doornberg JN, Ring DC, Kloen P. Long-term outcome of operatively treated fracture-dislocations of the olecranon. There is consensus opinion in the literature that elbow complex dislocations should be managed by immediate primary closed reduction followed by a thorough clinical examination and CT scan of the elbow. A posteriorly directed force results from a fall on an extended elbow, which levers the ulna out of the trochlea. This is usually left on for 4 weeks with extension limited to 30 degrees. Complex elbow dislocations encompass a large range of injuries from dislocations associated with undisplaced radial head fractures to significant bony injuries causing chronic instability. Cadaveric studies have reinforced the need to obtain post-reduction CT scans as the size of the coronoid fragment influences the long-term stability of the elbow. J Orthop Surg (Hong Kong) 2009; 17(1): 31-5. Heterotopic ossification formation after fracture-dislocations of the elbow. He performed a radial head arthroplasty, collateral ligament repair and "fiberwire stitches were placed in a lasso technique around the coronoid avulsed fracture. ", "It is a modern trend for publishers to establish open access journals. J Hand Surg Am 2010; 35(3): 464-7. Doornberg J, Ring D, Jupiter JB. In valgus stress, the MCL is stretched and the radiohumeral joint compressed, making these the primary stabilizers. Terrible triad elbow fracture-dislocation with triceps and flexor-pronator mass avulsion. In this perspective, open access journals are instrumental in fostering researches and achievements. 2015 Feb;38(2):e143-6. After closed reduction of the dislocation the treatment is the same as for a simple olecranon fracture; restoration of the articular surface with internal fixation and early mobilisation [56, 57, 60]. terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation ; coronoid fractures involving less than 10% of the coronoid do not confer elbow stability in cadaveric studies and therefore do not require repair The importance of AMCF and LCL injuries in causing long term instability and arthrosis has only been recognised in the last decade. ", "Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers. Acta Orthop Traumatol Turc 2014; 48(1): 102-5. Complex elbow dislocation; Coronoid fracture; Elbow fracture-dislocation; Radial head fracture; Terrible triad injury of the elbow. Dynamic stability encompasses the congruity of the articulation when the muscles crossing the elbow joint contract to enable movement [7]. ", "There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Doornberg JN, Ring DC. Terrible triad injuries of the elbow: Does the coronoid always need to be fixed? The “terrible triad” pattern is so named because the three combined injuries of elbow dislocation, radial head fracture and coronoid fracture significantly increase elbow instability and rate of complications [3-6]. A terrible triad combines three injuries: dislocation of the elbow, fracture of the radial head, and fracture of the coronoid. -, Instr Course Lect. We present the case of a unique association of the two injuries with an elbow dislocation, radial and coronoid process fractures and a distal radioulnar joint dislocation due to an interosseous membrane rupture. Morrey Bf, Sanchez-Sotelo J, eds. The “terrible triad injury” of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture. When the elbow is at rest, the anatomical structures providing stability are the ulnohumeral joint, medial collateral ligament complex (MCL), Lateral Collateral Ligament Complex (LCL) and the capsule [4]. J Orthop Trauma 2008; 22(5): 325-31. NLM Mortazavi SM, Asadollahi S, Tahririan MA. The injury is usually associated with typical soft-tissue disruptions (with common involvement of the lateral collateral ligament complex, elbow joint capsule, as well as the common extensor and flexor-pronator tendons) that are best understood in the context of injury mechanism as well as the role and relevance of the various elbow stabilizers. ", "Open access journals have become a fundamental tool for students, researchers, patients and the general public. Leigh WB, Ball CM. Traditionally, all damaged structures are repaired, including repair of the LCL to the lateral epicondyle, radiohumeral joint ORIF or replacement, coronoid process repair, MCL reconstruction [32] and capsular repair [34]. Large range of disciplines or both structures Jue Cao, Rodrigo Banegas 2006 ; 37 ( 3 ) 464-7! Has published over 230 papers, chapters and reviews primarily in the treatment of triad! Chen H, Ertürk C, Altay MA, Bilge A. Bipolar dislocation of the radial head and.... 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