Outcomes of coronoid-first repair in terrible triad injuries of the elbow

Zhang, Junren; Tan, Mark; Kwek, Ernest Beng Kee

doi:10.1007/s00402-017-2733-8

Cited by 18 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…IN THEIR CADAVERIC STUDY, cage DJ., et al found that the average anterior capsule attachment to the ulna is 6.4 mm distal to the coronoid tip and speculated that rarely, type 1 fractures could involve capsular detachment [20]. However, we found that all capsules were injured and avulsed from their insertion an- for coronoid tip repair in terrible triads injury as they found good clinical and radiographic outcomes postoperatively [15]. They suggested that a universal posterior midline incision is beneficial in medially and laterally approaching the elbow.…”

Section: Discussionmentioning

confidence: 53%

“…given the limited space [15]. What aided in exposure in our cases is that the radial heads were excised as they needed replacement;…”

Section: Discussionmentioning

confidence: 96%

“…Several studies have found that coronoid fractures involving less than 50% do not have significant instability in the setting of a radial head fracture involvement [9,10]. However, despite the small fragment, some support the need for coronoid repair as they believe it adds to elbow stability [14,15]. In this case series, we assessed the stability, range of motion, and functional outcome in 8 cases treated utilizing a single approach with a coronoid-first repair regardless of the process size involved with the replacement of unsalvageable comminuted radial fractures followed by LUCL repair.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Terrible Triad Fracture Dislocation Injury Review of Current Fixation Protocols and Illustration of Single Incision Technique in 8 cases “Case Series.”

Ali¹,

Alghamdi²,

Alkaff³

et al. 2023

Act Scie Ortho

View full text Add to dashboard Cite

Background: Terrible triad injuries are devastating clinical entities with different approaches described in the literature for fixation.Stability and an ideal range of motion are paramount for a favorable clinical outcome. The purpose of the study was to review the current protocols and surgical management of this complex injury and to assess the stability and range of motion of eight cases reported.Methods: Case series of patients involved in a non-salvageable radial head fracture. After surgery, the follow-up period was 27 months. The primary outcome measures were a range of motion and elbow stability intra-operatively and postoperatively. Secondary outcome measures were Mayo elbow performance scores.Results: Seven patients were included in the study, with a total of eight elbows presented with a terrible triad in our institute between February 2020 and May 2022. All cases reached the desired stability following coronoid repair, radial head replacement, and lateral ulnar collateral ligament repair (LUCL). Range of motion got 10 to 125 degrees on the twelfth week postoperatively. Mayo elbow performance and Disabilities of the Arm, Shoulder, and Hand Questionnaire scores were favorable at the final follow-up, with no chronic instability in all cases. Conclusion:Single incision using the Kocher approach, coronoid-first fixation using anchor suture is feasible following the removal of a comminuted radial head, followed by radial head replacement and LUCL repair resulting in desirable clinical outcomes. There is no superior current protocol for treating these injuries.

show abstract

Section: Discussionmentioning

confidence: 53%

“…given the limited space [15]. What aided in exposure in our cases is that the radial heads were excised as they needed replacement;…”

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Terrible Triad Fracture Dislocation Injury Review of Current Fixation Protocols and Illustration of Single Incision Technique in 8 cases “Case Series.”

Ali¹,

Alghamdi²,

Alkaff³

et al. 2023

Act Scie Ortho

View full text Add to dashboard Cite

show abstract

“…[5][6][7][8] Recent studies have analyzed results of standardized protocols for TTI. Giannicola et al 5 in a series of 26 patients and Zhang et al 20 analyzing 13 cases reported a mean MEPS of 95 and 85 and mean DASH of 8 and 21, respectively. Nonetheless, despite the satisfactory clinical outcomes reported by the authors, the mean follow-up of the first publication was 31 months and 27 months for the second study, failing to address the sustainability of the results at long-term follow-up.…”

Section: Discussionmentioning

confidence: 97%

Treatment of terrible triad injuries at a mean follow-up of nine years

et al. 2018

View full text Add to dashboard Cite

Background To evaluate the sustainability of the early clinical and radiological outcomes of terrible triad injuries at long-term follow-up. Methods Twelve consecutive patients who underwent fixation of terrible triad injuries with minimum of seven years of follow-up. Functional and radiological outcomes at one year and final follow-up were compared. We assessed Mayo Elbow Performance Score, Quick-Disability of the Arm Shoulder and Hand, and modified-American Shoulder and Elbow Surgeons Scores. Radiological evaluation included Broberg and Morrey classification and Hastings classification for heterotopic ossification. Results The mean age of patients was 55 years, with a median follow-up of 9.3 years. At final evaluation, mean flexion, extension, supination, and pronation were 145°, 6°, 82°, and 80°, respectively; mean Mayo Elbow Performance Score, modified-American Shoulder and Elbow Surgeons Scores, and Quick-Disability of the Arm Shoulder and Hand scores were, respectively, 97, 92, and 4.9 points. There was no statistical difference between early and final follow-up range of motion, Mayo Elbow Performance Score, and Quick-Disability of the Arm Shoulder and Hand. However, radiological changes were observed in 66% of the patients at final follow-up. Two patients underwent reoperation, with final satisfactory results. Conclusion Our results suggested that using a standardized protocol, satisfactory clinical outcomes at early follow-up could be maintained over time. However, early complications and osteoarthritic changes at long-term follow-up can be expected. Level of evidence Therapeutic IV Cases series.

show abstract

“…Elbow dislocation associated with both radial head and coronoid fractures earned its eponym “terrible triad injury” (TTI) for decades because of the poor prognosis [ 1 ]. With the improvement of knowledge on elbow biomechanics and pathoanatomy, the current standard strategy appeared to have yielded more favorable outcomes [ 2 , 3 ]. However, challenges persist.…”

Section: Introductionmentioning

confidence: 99%

Prediction and Potential Preventions for the Development of Posttraumatic Osteoarthritis after the Terrible Triad Injury: A Multicenter Risk Factors Study

Lin

et al. 2020

BioMed Research International

View full text Add to dashboard Cite

Objective. A multicenter study to evaluate risk factors for the development of moderate or severe posttraumatic osteoarthritis (PTOA) and to find potential preventions. Methods. We conducted a retrospective multicenter study including the terrible triad injury (TTI) patients with surgical treatment from January 2007 to November 2014. Demographics, injury information, and treatment history were obtained retrospectively. According to the Broberg and Morrey criterion, 198 included patients were sorted into two groups: the mild or no PTOA and moderate or severe PTOA. Uni- and multivariate logistic regression analyses were used to identify risk factors for moderate or severe PTOA. Results. Moderate or severe PTOA was present in 64 patients (32.3%). Significant risk factors were Mason III radial head fracture (OR 4.049, 95% CI 1.877-8.736, p<0.001), medial collateral ligament injury (OR 5.120, 95% CI 1.261-20.790, p=0.022), and heavy use of elbow (OR 2.333, 95% CI 1.060-5.136, p=0.035). Besides, patients suffered subluxation (p=0.007) and those with more risk factors had a higher risk to develop moderate or severe PTOA. Conclusions. Moderate or severe PTOA was common after the TTI. Patients need to be counseled about avoiding heavy use of the elbow, especially for those with Mason III radial head fractures. Surgeons should be aware of the recurrent instability of the elbow.

show abstract

Outcomes of coronoid-first repair in terrible triad injuries of the elbow

Cited by 18 publications

References 19 publications

Terrible Triad Fracture Dislocation Injury Review of Current Fixation Protocols and Illustration of Single Incision Technique in 8 cases “Case Series.”

Terrible Triad Fracture Dislocation Injury Review of Current Fixation Protocols and Illustration of Single Incision Technique in 8 cases “Case Series.”

Treatment of terrible triad injuries at a mean follow-up of nine years

Prediction and Potential Preventions for the Development of Posttraumatic Osteoarthritis after the Terrible Triad Injury: A Multicenter Risk Factors Study

Contact Info

Product

Resources

About