Operative Treatment of Terrible Triad of the Elbow via Posterolateral and Anteromedial Approaches

Abstract

The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow. The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. The mechanism of injury included fall from height in 9 patients and traffic accident in 3. According to O’Driscoll classification for fractures of the ulnar coronoid, there were 11 patients with type Ⅰ and 1 with type Ⅱ fractures. According to Mason classification for fractures of the radial head, there were 3 patients with type Ⅰ, 7 with type Ⅱ and 2 with type Ⅲ fractures. All patients were followed up for 12-27 months (average 15.5 months), which showed no pain or severe pain in all patients except for 2 patients with mild pain. At the last follow-up, the mean flexion was for 125°(range, 90°-140°), the mean extension loss for 20°(range, 0°-70°), the mean pronation for 66°(range, 20°-85°) and the mean supination for 60°(range, 30°-85°). The bony union time was 8-14 weeks (average 11 weeks) and the elbows were stable in flexion-extension and varus-valgus in all patients. The elbows maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation. Mild heterotopic ossification of the elbow occurred in 3 patients at 6 months after operation and mild degenerative change in 1 patient at 18 months after operation. The Broberg and Morrey elbow performance score was 82 points (range, 58-98 points). The results were excellent in 6 patients, good in 4, fair in 1 and poor in 1, with excellence rate of 83.3%. The results showed that the combined posterolateral and anteromedial approaches can facilitate the reduction and fixation of terrible triad of the elbow. Repair of radial head, coronoid, medial and lateral collateral ligaments can sufficiently restore the elbow stability, allow early postoperative motion and enhance the functional recovery.

Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach

“…The functional outcomes of this current series were similar to the findings reported in previous studies, with a mean flexion–extension arc of 100° to 127°, a mean supination–pronation arc of 126° to 156°, and a mean MEPS of 81 to 96 points. 2 – 8 , 27 – 32 However, the rate of secondary surgery was lower in this current series than that reported by others, with only three patients requiring secondary procedures in this series. 2 – 8 , 27 – 32 …”

Evaluation of effect and safety of arthroscopic surgery with three different operative approaches in patients with terrible triad of the elbow

“…All participants met diagnostic criteria of TTE. [ 7 ] All the patients were diagnosed with unilateral fracture, 126 with TTE of left, 135 with TTE of right. The causes of injury included 66 from falls, 40 from traffic accidents, and 155 from intense collisions.…”

“…[ 6 ] Traditional nonoperative method has been proven poor in the treatment of TTE due to repetitive instability and stiffness induced by long-term fixation, and operative treatment for TTE is advocated at present. [ 7 , 8 ] Heterotopic ossification is a common complication follows elbow fracture surgery, which can significantly impair the range and function of motion. [ 9 ] Hence, it is of great value to have a research on the efficacy of operative approaches in TTE.…”

An unusual coronoid fracture in a fragment of ulna recovered from the Prehistoric site of Buraca da Moira Rock Shelter (Boa Vista, Leiria)

“…The posterior portion of the trochlear notch is formed by the olecranon, and the anterior portion of a triangular-shaped protrusion, the so-called coronoid process (Wells and Ablove, 2008;Xiao et al, 2015). The coronoid process and associated soft tissues -the anterior joint capsule of the elbow, the brachialis muscle and the medial ulnar collateral ligament (MUCL) -are pivotal to stabilize the elbow joint as well as to resist varus stress, prevent backward dislocation and posterior-lateral subluxation (Ring, 2006;Chen et al, 2015).…”