Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping review

Stambulic, Thomas; Desai, Veeral; Bicknell, Ryan T.; Daneshvar, Parham

doi:10.1016/j.xrrt.2022.01.002

Cited by 5 publications

(6 citation statements)

References 48 publications

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“…8 From the available literature, surgical treatment for TT achieves mean post-operative ROM of 130 ± 7° flexion, 15 ± 6° extension, 66 ± 10° supination and 69 ± 11° pronation. 9–16 Sixteen of our patients treated without surgery achieved a functional ROM, adequate for their activities of daily living (ADL). Our outcomes demonstrate managing these injuries non-operatively in selective cases results not only in similar flexion–extension arcs to operative management but improved prono-supination, while additionally negating the risks of an anaesthetic and complications directly related to surgery.…”

Section: Discussionmentioning

confidence: 97%

Non-operative management of terrible triad injuries of the elbow; not so terrible?

et al. 2023

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Introduction Terrible triad injuries (TTIs) of the elbow have traditionally been reported to have poor outcomes, hence requiring surgical stabilisation. We identified and reviewed patients with TTIs treated non-operatively within our department. Methods We retrospectively reviewed patients with TTI treated non-operatively with standardised elbow-instability rehabilitation from 2010 to 2020. We used Mason and Morrey classifications for radial head and coronoid fractures, respectively. Non-operative indications included a congruent joint on CT, significant co-morbidities pre-disposing to high-risk surgery and/or patient preference. Outcomes included Oxford Elbow Score (OES), ROM and complications. Results Nineteen patients were included (mean age 49; 37% female). At an average of 6 years (range 2–11 years) post-treatment, mean OES was 46 ± 7. At last clinic review, mean 6 months (2–15), average ROM was 131 ± 11° flexion, 8 ± 10° extension, 85 ± 12° supination and 85 ± 13° pronation. One patient required arthrolysis and another had an incongruent ulnohumeral joint which developed clicking with a functional ROM. Conclusion Our report suggests non-operatively managed and appropriately rehabilitated TTI injuries can achieve good function and ROM. We recommend conservative management as a viable option in cases with joint congruency and no mechanical block in patients with significant co-morbidities or those refusing surgery but patients must be assessed on a case-by-case basis.

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Section: Discussionmentioning

confidence: 97%

Non-operative management of terrible triad injuries of the elbow; not so terrible?

et al. 2023

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“…Recent studies showing better understanding and management of such injuries have shown significant improvement in their outcomes. 5 , 6 WALANT has been an increasingly popular technique that may help in the improvement of clinical outcomes of terrible triad injuries.…”

Section: Discussionmentioning

confidence: 99%

Wide-Awake Approach for Terrible Triad Injury Fixation: A Report of Two Cases

Magtoto¹,

Alagar²

2023

Journal of Hand Surgery Global Online

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“…Така назва була обумовлена негативними результатами лікування, які супроводжувались нестабільністю (вивихами), контрактурами, розвитком посттравматичного артрозу та больовим синдромом [1,2]. Лікування травм ліктьового суглобу, що попозначають як «нещаслива тріада», викликає багато питань стосовно діагностики та хірургічної тактики, що відповідно негативно відбивається і на результатах лікування таких пацієнтів [3,4,5].…”

Section: вступunclassified

“…Труднощі у лікуванні таких пацієнтів обумовлені тим, що внутрішньосуглобові переломи та ушкодження зв'язкового апарату призводять до нестабільності ліктьового суглоба, яка може бути усунута шляхом використання специфічних хірургічних прийомів та засобів фіксації. На сьогоднішній день, концепція та протоколи лікування «нещасливої тріади» детально розроблені і передбачають остеосинтез або протезування голівки променевої кістки, остеосинтез вінцевого відростку при переломах 2-3 ступеня та відновлення ушкоджених зв'язок [7,8,6,9,10,4,5,11].…”

Section: вступunclassified

“…Для шва або пластики бічних зв'язок може бути використаний відповідний бічний або розширений задній доступ. У свіжих випадках відновлення ушкоджених бічних зв'язок доцільно виконувати шляхом анкерної черезкісткової фіксації [8,6,9,5,26]. При застарілих ушкодженнях переважно виконували пластику ушкоджених зв'язок.…”

Section: обговоренняunclassified

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Surgical Treatment of the Terrible Triad of the Elbow

Kurinnyi,

Strafun

2023

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Summary. The so called “terrible triad” injury of the elbow, which includes a combination of posterolateral dislocation of the forearm with fractures of the radial head and coronoid process, accounts for 10%-11% of all elbow fractures in adults. This type of elbow injury remains difficult to treat and is often accompanied by a high level of complications: instability, contractures, deformable arthrosis, and pain syndrome. Objective: to assess the effectiveness of surgical treatment of patients with the terrible triad of the elbow, depending on the duration of the injury and the features of osteosynthesis of the coronoid process using certain approaches. Material and Methods. The surgical treatment of 87 patients with the terrible triad of the elbow was analyzed. The age of the patients was 40.9±2.6 years. The average term of admission to treatment was 5.5±4.1 months after the injury. 59 patients were admitted in less than 30 days and 28 patients were admitted after 30 days. The preoperative examination included X-ray and CT; sonographic and EMG studies were performed if necessary. Surgical treatment consisted of repositioning and osteosynthesis of the coronoid process, osteosynthesis or prosthetics of the radial head, and restoration of the damaged lateral ligaments of the elbow joint. In cases of consequences of injury, in addition, mobilization of the elbow joint was performed, osteosynthesis was supplemented with bone autograft, and damaged ligaments were restored plastically. After the surgery, the elbow joint was immobilized in the extension position of 30-20 degrees. Postoperative rehabilitation begins on the first day after surgery and involves one cycle of flexion and extension during the day from the extension position of 20-30° to flexion position of 100-120°. Immobilization in the extension position of 20-30° is basic and is used in the evening and at night. Results. The results were evaluated according to the MEPS system in 56±6.2 months. In the group of patients who underwent surgery within 30 days, the MEPS function index was 90.3±2.1 points; when surgery was performed more than 30 days after the injury, statistically worse results were achieved (83.5±2.9 points). We also compared the outcomes of treatment depending on the access to osteosynthesis of the coronoid process. When performing an anterior approach to the coronoid process, the MEPS index was 90.1±3.2 points, which was better than in case of other approaches. Conclusions. Thus, it has been proven that better results in the surgical treatment of the terrible triad are obtained in the group of patients who underwent surgery up to 30 days after the injury compared to later admission to treatment. The advantages of the anterior approach for grade 2-3 coronoid process fractures have been proven. Our proposed early dosed rehabilitation plays an important role in the treatment of such patients.

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Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping review

Cited by 5 publications

References 48 publications

Non-operative management of terrible triad injuries of the elbow; not so terrible?

Non-operative management of terrible triad injuries of the elbow; not so terrible?

Wide-Awake Approach for Terrible Triad Injury Fixation: A Report of Two Cases

Surgical Treatment of the Terrible Triad of the Elbow

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