The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. Module. The objective was to analyze the long-term clinical outcome of terrible triad injury of the elbow following surgical intervention with a single lateral approach. The treatment of terrible triad injuries of the elbow continues to evolve. Skin incisions: 1.1.1. These injuries make up about 30% of elbow dislocations, and are generally caused by falling onto an outstretched arm. With operative treatment, the surgeon should attempt to perform internal fixation of the coronoid fracture, to regain normal radiocapitellar contact (either by preserving the radial head with open reduction and internal Operative treatment: 1. The anteromedial coronoid fracture was repaired with a suture anchor through an anteromedial approach. NIH 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 Generally these should commence around day 7-10 for a terrible triad or elbow dislocation unless otherwise specified in the operating report. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications … terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation. The purpose of treatment in the terrible triad injury is to restore the congruency of the elbow joint, its stability and an optimal ROM. This may be done as below, or in a hinged range of motion brace or x-fix if applied. The terrible triad of the elbow is a difficult-to manage injury and, even with appropriate treatment, it is only rarely possible to achieve a normal elbow after the treatment. Injury. Intervals: 1.2.1. Login. The goal of treatment for terrible triad injuries is restoring the bony anatomy and reconstructing the ligamentous restraints of the elbow to provide enough stability for early elbow … Liu G, Hu J, Ma W, Li M, Xu R, Pan Z. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach. Prevention of these severe complications requires initial understanding of the lesion mechanism and precise analysis of all lesions. The terrible triad of the elbow is a difficult-to manage injury and, even with appropriate treatment, it is only rarely possible to achieve a normal elbow after the treatment. Abstract: Operative treatment for complex elbow injuries has evolved. Fracture union and concentric reduction of both the ulnotrochlear and radiocapitellar articulations were achieved in all patients. Specialty. Select Management. Extensors are elevated off th… Login. Joaquin Sanchez-Sotelo. 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. 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. dislocation is a common injury, its treatment has been traditionally associated with unsatisfactory outcomes and high complication rates [1–5]. Conclusions: When an elbow joint is affected by the terrible triad, it is very unstable and prone to numerous complications. (1) 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. 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. The terrible triad is an uncommon injury, which includes an elbow posterior dislocation with fractures of the radial head and coronoid process of the ulna. Joaquin Sanchez-Sotelo. Terrible triad of the elbow: is it still a troublesome injury? Surgeons performed fixation of the radial head fracture and repair of the lateral collateral ligament through a lateral approach and fixation of the coronoid fracture through an anteromedial approach. Select Management. USA.gov. 4 and 5). 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. 4th ed. In the elbow with persistent instability after repair of these element … -, Egol KA, Immerman I, Paksima N, et al. We use cookies to help provide and enhance our service and tailor content and ads. Preoperative lateral (A) and anteroposterior (AP) (B) radiographs show a Mason type II radial head fracture, an O’Driscoll anteromedial subtype 3 coronoid fracture, and dislocation of the elbow joint. Algorithm for surgical treatment of terrible triad elbow injuries. Intervals: 1.2.1. Hotchkiss RN . 1.2. Clipboard, Search History, and several other advanced features are temporarily unavailable. The mean ± SD MEPS was 88.1 ± 12.2 points, with results classified as excellent in eight elbows, good in ten, and fair in four. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People's Hospital. Radial head replacement might be a more effective treatment approach with good clinical outcomes for patients with a terrible triad of the elbow. Some of the most common injury classification systems cited in … Injury 2014; 45: 942–948. We treated twenty-five patients with terrible triad injury of the elbow from July 1, 2017, to June 30, 2020, and performed post hoc analysis. should instability persist after addressing the radial head and the LCL complex in the presence of a small coronoid fracture, the next best step is MCL reconstruction. By Joaquin Sanchez-Sotelo 58 Videos. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Preoperative anteroposterior (AP) radiograph (A) and three-dimensional computed tomography (B) images show a Mason type III radial head fracture and an O’Driscoll anteromedial subtype 1 coronoid fracture. The terrible triad of the elbow is characterized by great potential for joint instability and an unfavorable prognosis.1, 5Surgical treatment is the therapy of choice in the vast majority of cases, with the aims of restoration of the anatomy and early mobility. Related Content AUTOPLAY ON. Gupta A, Barei D, Khwaja A, et al. The goals of surgery include (1) reestablishing the support provided by the radial head, (2) performing a dedicated, secure ligament repair, and (3) fixing the coronoid fracture (if the fractured coronoid piece is small, it may not require fixation). The Elbow Terrible Triad - Surgical Treatment. See this image and copyright information in PMC. (eds) Rockwood and Green’s fractures in adults. Preoperative lateral radiograph (A) and three-dimensional computed tomography (B) images show a Mason type II radial head fracture and an O’Driscoll anteromedial subtype 2 comminuted coronoid fracture after closed reduction of elbow dislocation. Objective To report the results of the surgical treatment of terrible triad injury with anteromedial coronoid fracture through a combined surgical approach. Therefore, the preferred surgical treatment options in the setting of terrible triad injuries include open reduction and internal fixation (ORIF) or radial head arthroplasty . Diagnosis. The goal of surgical treatment of the terrible triad of the elbow is the restoration of humeroulnar and humeroradial stability, thus facilitating the early onset of elbow movement in the postoperative period in order to reduce the probability of long-term joint dysfunction and stiffness. Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. Some aspects of treatment are controversial: systematic medial collateral ligament repair, or use of an articulated external fixator. Response to the Letter to Editor Regarding "Lateral Approach and Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis". The short-term and long term results are historically poor, with a … The aims of the present paper were to summarize the anatomic and pathophysiological bases, highlight the crucial importance of the humeroradial column and lateral collateral ligament, and to determine the importance of the coronoid process. 2018;85(2):102-108. 2017 Apr;29(2):125-137. doi: 10.1007/s00064-017-0489-5. Bull Emerg Trauma. Diagnosis. Single- staged treatment using a standardized protocol results in functional motion in the majority of patients with a terrible triad elbow injury. Conservative treatment was attempted (due to the patient’s general status). The radial head fracture was fixed with screws, and the lateral collateral ligament was repaired by transosseous sutures through a lateral approach. Results Twenty-two patients (15 males, seven females; mean ± SD age, 47.5 ± 11.4 years) were enrolled in this study. - in this injury there is little to keep the elbow reduced; - general operative considerations: 1) radial head: repair or replacement of the radial head (see ORIF or radial head) - concomitant excision of radial head and coronoid process is not performed since it may result in … COVID-19 is an emerging, rapidly evolving situation. 2005 Mar;87 Suppl 1(Pt 1):22-32. doi: 10.2106/JBJS.D.02933. This objective remains a challenge for surgeons due to the complexity of the lesion.5 All terrible triad injuries require surgical repair. METHODS: We retrospectively reviewed terrible triad of the elbow injuries treated at our hospital using a modified surgical technique. 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