Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures

Pugh, David M.; Wild, Lisa M.; Schemitsch, Emil H.; King, Graham J.W.; McKee, Michael D.

doi:10.2106/00004623-200406000-00002

Cited by 371 publications

(320 citation statements)

References 13 publications

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“…Nevertheless, neurovascular complications were seen mainly in simple dislocations in contrast to those found in complex dislocations. This distribution is in agreement with the literature in relation to fracture-dislocations [21][22][23]25]. However, neurovascular injury prevalence is higher in open dislocations than in closed dislocations [4].…”

Section: Discussionsupporting

confidence: 91%

Comparative Study of Simple and Complex Open Elbow Dislocations

Boretto

Sammartino

Gallucci

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Open elbow dislocations are rare injuries. Most of the evidence related to these dislocations is found in case reports or in series with closed injuries. We reviewed the experiences of three centers in the treatment of open elbow dislocations. Question/purposes We compared the results after operative treatment of simple and complex open dislocations in terms of (1) ROM, (2) functional score, and (3) complications. Methods Eighteen patients were retrospectively included in this study: 11 with simple open elbow dislocations and seven with complex open elbow dislocations. Mean age was 40 years. Thirteen were men. Eight patients presented neurovascular injuries. Evaluation included ROM of the elbow and forearm as measured by hand-held goniometer. We then classified the results using the 100-point Broberg and Morrey functional rating index based on ROM, grip strength, elbow stability, and pain. Scores of 95 to 100 were considered excellent, 80 to 94 good, 60 to 79 fair, and less than 60 poor. Complications were recorded. Minimum followup was 6 months (mean, 25 months; range, 6-72 months). Results We found no differences between simple and complex open elbow dislocations related to ROM (median flexion/extension: 117°versus 110°, p = 0.12; forearm rotation: 160°versus 170°, p = 0.67). According to the Broberg and Morrey score, four patients had excellent results, five good, and one fair in the simple dislocation group, whereas in the complex dislocation group, four patients had excellent results, two good, and one fair (p = 0.8). No difference in complication rate was found between groups (p = 0.63). All complications in the simple dislocation group were neurovascular. In the complex dislocation group, there was one case of brachial artery occlusion, two cases of heterotopic ossification, one case of infection and nonunion, and one case of infection. No patients had recurrent elbow instability.

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Section: Discussionsupporting

confidence: 91%

Comparative Study of Simple and Complex Open Elbow Dislocations

Boretto

Sammartino

Gallucci

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…A systematic approach to management of elbow fracturedislocations that surgically addresses each individual component of the terrible triad pathoanatomy has resulted in improved results in terms of pain and functional outcomes [4,5,19,24], but instability, contracture, reoperation, and progression to arthrosis remain clinically important problems. One recent study analyzed the important role of the treatment of the radial head fracture within the framework of a larger protocol [13].…”

Section: Discussionmentioning

confidence: 99%

“…In the current study, we had a multicenter cohort to broaden the patient sample and evaluate the management of terrible triad injuries in a different context. Patients were treated with a standard surgical algorithm consistent with previously published reports [4,5,19,24]. Briefly, for the radial head fracture component of the triad, the radial head was internally fixed when there were fewer than four articular fragments without traumatic delamination of the articular cartilage and no comminution of the radial neck.…”

Section: Methodsmentioning

confidence: 99%

“…The operative technique was similar to that described by Pugh and McKee [15,19]. Patients were positioned supine with a tourniquet on the proximal arm.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Several recent studies [4,5,19,24] that applied algorithmic approaches to managing each individual injury in the triad have demonstrated more promising results than historical studies [11,20,21] that previously documented high rates of persistent pain, posttraumatic arthrosis, contractures, instability, and functional limitations after treatment. These surgical protocols recommend various fixation techniques for each of the three critical aspects of terrible triad pathoanatomy.…”

Section: Introductionmentioning

confidence: 99%

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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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Elbow Dislocations

Howard

Pollock

2021

Evidence‐Based Orthopedics

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Standard Surgical Protocol to Treat Elbow Dislocations with Radial Head and Coronoid Fractures

Cited by 371 publications

References 13 publications

Comparative Study of Simple and Complex Open Elbow Dislocations

Comparative Study of Simple and Complex Open Elbow Dislocations

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

Elbow Dislocations

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