Objective: To analyze the risk factors of elbow stiffness following open reduction and internal fixation of the terrible triad of the elbow joint. Methods: A retrospective study was conducted of 100 patients with the terrible triad of the elbow joint, who had been treated at our hospital from January 2015 to December 2018. All patients were treated with a loop plate to repair the ulnar coronoid process. According to the severity of the injury, the radial head was either fixed or replaced, and the lateral collateral ligament was repaired with an anchor. According to the range of motion of the elbow during the last follow-up, the patients were divided into two groups. The stiffness group (displayed extension-flexion or pronationsupination <100) consisted of 30 patients. The second group, named the non-stiffness group (exhibited extensionflexion and pronation-supination ≥100), consisted of 70 patients. Related risk factors included age, gender, smoking, diabetes, whether the fracture is on the dominant side, mechanism of injury, fracture classification, time from injury to surgery, configuration of internal fixation of the radial head, postoperative immobilization time, and use of anti-heterotopic ossification drugs (oral indomethacin). Both t-test and chi squared test were used to analyze any significant differences. Only the variables with a P < 0.05 in the tests were retested into a logistic multiple regression in order to screen risk factors of elbow stiffness. Results: All patients were followed up for 12-48 months (average, 25.7 months), and all patients exhibited bone healing. Multivariate regression analysis showed that high-energy injury (OR = 3.068, 95% CI 1.134-8.295, P = 0.027), time from injury to surgery > 1 week (OR = 2.714, 95% CI 1.029-7.159, P = 0.044), and postoperative immobilization time (OR = 3.237, 95% CI 1.176-8.908, P = 0.023) were independent risk factors of elbow stiffness after surgery for the terrible triad of the elbow. Conclusion: High-energy injury, the time from injury to surgery > 1 week, and postoperative joint immobilization time > 2 weeks are the independent risk factors of elbow stiffness after surgery of the terrible triad of the elbow, which should be treated carefully in clinical treatment.

PurposeTo explore the clinical outcomes of a hinged external fixator combined with internal fixation in treating complex elbow fractures.MethodsThis was a retrospective analysis of 42 cases of complex elbow fractures treated in our hospital from January 2015 to December 2019. Twenty-four cases were treated with a hinged external fixator combined with internal fixation (external fixation group), including 14 cases of the terrible triad of the elbow, 5 cases of posterior Monteggia fracture, and 5 cases of transolecranon fracture-dislocation. Eighteen cases were treated with adjustable brace fixation combined with internal fixation (brace group), including 11 cases of the terrible triad of the elbow, 3 cases of posterior Monteggia fracture and 4 cases of transolecranon fracture-dislocation. All patients were treated with open reduction and internal fixation, and the patients with postoperative elbow instability underwent fixation with a hinged external fixator or adjustable brace. Preoperative and surgical data were collected. At the last follow-up, elbow motion (extension-flexion, rotation) was recorded in the two groups of patients, and the Mayo Elbow Function Score (MEPS) was used to assess elbow joint function.ResultsAll patients were followed up for 12 to 55 months (mean 28.2 months). The bones healed in all patients with fractures; the healing time was 12.9±1.9 weeks for the external fixation group and 12.2±1.8 weeks for the brace group, and the difference was not statistically significant (P＞0.05). The average flexion-extension range of the elbow joint in the external fixation group was 128.8°±15.7°, the average rotation range of the forearm was 142.7° ± 21.5°, and the average MEPS score was 89.8±11.3 points (range 60-100 points); 14 cases were excellent, 7 cases were good, 2 cases were fair, and 1 case was poor. The excellent and good rate was 87.5%. In the brace group, the average flexion-extension range of the elbow joint was 110.3°±37.0°, the average rotation range of the forearm was 125.6°±30.5°, and the average MEPS score was 81.1±15.5 points (50-100 points); 8 cases were excellent, 5 cases were good, 2 cases were fair, and 3 cases were poor. The excellent and good rate was 72.2%. The difference between the two groups was statistically significant (P <0.05).ConclusionsThe combination of an external fixator and internal fixation in the treatment of unstable complex elbow fractures can better restore the stability and function of elbow joints than can adjustable brace fixation.