CORHD Lesions: A New Pediatric Terrible Triad of the Elbow. A Case Report and Literature Review

Abstract

Background context:The osteoarticular pathology of the elbow includes a number of complex lesions, the best known being the Monteggia fracture-dislocation, the anterior Trans olecranon fracture-dislocation and the terrible triad of the elbow. The diagnosis and treatment of these injuries require the medical practitioner to have solid knowledge to establish an early diagnosis and optimal treatment in order to fully recover the elbow function. When faced with a novel case involving complex lesions that cannot be included in the known pathology, the orthopaedist needs to use conceptual reasoning to make a detailed analysis of the historical data and previously-described associated lesions, and then compare them with those under study.Purpose: To present a novel case and identify its place within the complex elbow injuries. The current case report can help orthopaedic and trauma surgeons to identify this rare and complex lesion.Study Design/Setting: Each lesion was identified and interpreted. Analysis in the context of scientific data was performed after each investigation and for each lesion or lesion group described in the literature. The evaluation confirmed or denied each condition.Patient Sample: A 12-year-old male patient presented to the Emergency Unit with a traumatic elbow and was immediately hospitalized. He was clinically examined and explored by radiology and imaging. Three lesions difficult to include in the known pathology were identified.Outcome Measures: Each diagnostic stage was evaluated based on both the accumulated knowledge and literature review. The final diagnosis was established step by step, after which the patient underwent surgery. Methods:The presence of an elbow showing obvious clinical signs of a major impact and an apparently harmless radiological aspect known as TRASH (The Radiographic Appearance Seemed Harmless) suggested possible osteochondral lesions. Special attention was paid to radiological and imaging details. The data revealed by these investigations were compared with those in the literature and it has emerged that a new terrible triad is in question.