Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow

Leigh, Warren; Ball, Craig M.

doi:10.1016/j.jse.2012.03.005

Cited by 95 publications

(66 citation statements)

References 19 publications

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“…The following is a brief summary of the results from studies in which >1 patient experienced the same complication. Leigh et al [24] reported that 2 of 23 (8.7%) patients experienced symptomatic nonunion of the radial head and neck or were unable to regain a functional range of motion despite >6 months of rehabilitation. Garrigues et al [22] reported that 3 of 40 (7.5%) patients experienced limited flexion, residual instability, or had an oversized radial prosthesis.…”

Section: Resultsmentioning

confidence: 99%

Complications of Treating Terrible Triad Injury of the Elbow: A Systematic Review

Chen¹,

Liu

2014

PLoS ONE

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ObjectiveTerrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications following surgical management of TTIE.MethodsMedline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had TTIE, and were published in English. Outcomes of interest were functional outcomes and complications.ResultsSixteen studies, involving 312 patients, were included in the systematic review. Mean follow up after surgery was typically 25 to 30 months. Mean Mayo elbow performance scores ranged from 78 to 95. Mean Broberg-Morrey scores ranged from 76 to 90. Mean DASH scores ranged from 9 to 31. The proportion of patients who required reoperation due to complications ranged from 0 to 54.5% (overall = 70/312 [22.4%]). Most of these complications were related to hardware fixation problems, joint stiffness, joint instability, and ulnar neuropathy. The most common complications that did not require reoperation were heterotopic ossification (39/312 [12.5%] patients) and arthrosis (35/312 [11.2%] patients).ConclusionsThe results of this systematic review indicate that functional outcomes after surgery for TTIE are generally satisfactory and that complications are common. Further research is warranted to determine which surgical techniques optimize functional outcomes and reduce the risk of complications.

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Section: Resultsmentioning

confidence: 99%

Complications of Treating Terrible Triad Injury of the Elbow: A Systematic Review

Chen¹,

Liu

2014

PLoS ONE

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“…One recent study analyzed the important role of the treatment of the radial head fracture within the framework of a larger protocol [13]. We found that patients who received radial head arthroplasty as part of an algorithmic approach to the management of terrible triad injuries had comparable pain and functional scores to those treated with ORIF.…”

Section: Discussionmentioning

confidence: 96%

“…We found no differences in clinical outcome measures between the two groups, including the DASH score, Broberg-Morrey index, and total arc of motion. A recent study by Leigh and Ball [13] including 23 patients (24 elbows) also compared outcomes of terrible triad injuries based on either radial head repair or replacement [13]. In that study, the radial head arthroplasty group had a slight but statistically significant advantage in terms of DASH scores (10.3 versus 9.16); however, the authors acknowledged that such a small difference may be of little, if any, clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Watters

Garrigues

Ring

et al. 2014

Clinical Orthopaedics &Amp; Related Research

111

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Background Surgical treatment for terrible triad injuries of the elbow (defined as elbow dislocations with concomitant fractures of the radial head and coronoid) remains a challenging clinical problem. Specifically, the question of whether to repair or replace the radial head remains controversial. Questions/purposes We compared patients with terrible triad injuries of the elbow whose radial head fracture was treated with either internal fixation and internal fixation (ORIF) or radial head arthroplasty in terms of (1) clinical outcome measures (DASH and Broberg-Morrey scores, ROM), (2) elbow stability and radiographic signs of arthrosis, and (3) complications and reoperation rates. Methods Retrospective review identified 39 patients with terrible triad injuries and minimum 18-month complete clinical and radiographic followup (mean, 24 months; range, 18-53 months). Patients were managed with a standard algorithm consisting of (1) repair (n = 9) or replacement (n = 30) of the radial head, (2) repair of the lateral ulnar collateral ligament, and (3) repair of the coronoid fracture. During the study period, the radial head generally was internally fixed when there were fewer than four articular fragments; otherwise, it was replaced. Evaluation included the DASH score, the Broberg-Morrey index, measurements of elbow stability and motion, and radiographic assessment for signs of arthrosis; chart review was performed for complications and reoperations. Complete followup was available on 87% (39 of 45 patients).

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“…Terrible triad injuries of the elbow have historically been challenging injuries to treat and although initial treatment protocols were limited because of small sample sizes and high complication rates, recent studies have shown more predictable results [11,16,18,22,30]. The aim of this study was to evaluate the algorithm used at one high-volume trauma center, which relies on biomechanical and clinical principles of functional anatomy and how it relates to postoperative stability [1-6, 12, 13, 24] and early ROM.…”

Section: Discussionmentioning

confidence: 99%

Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury

Gupta

Barei

Khwaja

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Terrible triad injuries of the elbow, defined as elbow dislocation with associated fractures to the radial head and coronoid, are associated with stiffness, pain, and loss of motion. Studies to date have consisted of small sample sizes and used heterogeneous surgical techniques, which render comparisons difficult and unreliable. Questions/purposes In a group of patients treated under a standard surgical protocol, we sought to determine the early dislocation rate, the range of motion in those not undergoing secondary procedures, the frequency and types of secondary surgical interventions required, the difference in motion between those undergoing secondary surgery and those who did not, and the frequency of heterotopic ossification and patient-reported stiffness. Methods Patients underwent a surgical protocol that involved fixing the coronoid, fixing the radial head if possible, otherwise performing radial head arthroplasty, and repairing the lateral ligamentous structures. Patients were excluded if ipsilateral upper extremity fractures from the humerus to the distal forearm were present. Fifty-two patients had a minimum followup of 6 weeks and were included for the early dislocation rate, and 34 of these (65%) had a minimum of 6 months followup and were included for the rest of the data. Eighteen of the 52 (35%) were considered lost to followup because they were seen for less than 6 months postsurgically and were excluded from further analysis. Chart review was performed to determine the presence of early dislocation within the first 6 weeks after surgery, range of motion in patients not requiring a secondary procedure, the frequency and types of secondary procedures required, the range of motion before and after a secondary procedure if it was required, and postoperative stiffness. Postoperative radiographs were analyzed to determine the presence and severity of heterotopic ossification. Results One of 52 patients sustained a dislocation within the first weeks of surgery (1.9%). Those not undergoing a secondary procedure were able to achieve a flexion arc of 110°and a supination-pronation arc of 148°. Nine of 34 patients (26%) underwent a secondary surgical procedure with stiffness, heterotopic ossification, and ulnar neuropathy being the most common surgical indications. Before secondary surgical procedures, patients had a flexion arc of 57°a nd a supination-pronation arc of 55°, which was less than those only requiring primary surgery alone (p \ 0.001). After secondary surgery, patients were able to achieve a flexion arc of 96°and a supination-pronation arc of 124°, which was not different from those who did not undergo reoperation (p = 0.09 and p = 0.08, respectively). Twentyeight of 34 patients demonstrated evidence of heterotopic ossification on radiographs, whereas 20 patients, including all nine undergoing secondary procedures, reported stiffness at the elbow.

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Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow

Cited by 95 publications

References 19 publications

Complications of Treating Terrible Triad Injury of the Elbow: A Systematic Review

Complications of Treating Terrible Triad Injury of the Elbow: A Systematic Review

Fixation Versus Replacement of Radial Head in Terrible Triad: Is There a Difference in Elbow Stability and Prognosis?

Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury

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