Anatomy, Definition, and Treatment of the “Terrible Triad of the Elbow” and Contemplation of the Rationality of this Designation

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.

Dislocations of the elbow – An instructional review

“…An intact coronoid process 11 is necessary to counter posteriorly directed forces and plays an important role in stabilising the elbow 12 13 . B Morrey has aptly described the coronoid process as the 'most important piece of real estate in the elbow' (personal communication).…”

Three-dimensional printing designed customized plate in the treatment of coronal fracture of distal humerus in teenager: A case report

“…Individualized 3- dimensional printing designed anatomical plates that better match the patient’s biomechanical request were developed on the model under the principle of not affecting the smoothness of the joint surface and to avoid restricting the mobility of the elbow joint with satisfactory mechanical stability. [ 21 ]…”

“…Individualized 3-dimensional printing designed anatomical plates that better match the patient's biomechanical request were developed on the model under the principle of not affecting the smoothness of the joint surface and to avoid restricting the mobility of the elbow joint with satisfactory mechanical stability. [21] Then the internal fixation is evaluated in vitro. The difficulty of fracture reduction and plate positioning were rehearsed repeatedly preoperatively.…”

Risk factors of efficacy for patients receiving surgical treatment following terrible triad of the elbow joint

“…[4] This injury is known to occur when the forearm is in supination, the elbow joint is extended and/or abducted, and great force is exerted in the axial direction. [5] However, it remains to be a disease that is difficult to cure and has poor prognoses owing to persistent elbow instability and other complications such as malunion, arthrofibrosis, heterotopic ossification, and ulnar neuropathy. [6,7] Therefore, it is essential to further increase the understanding of the injury mechanism, relevant anatomy, and factors related to elbow stability to effectively treat this.…”