Terrible triad of the elbow: treatment protocol and outcome in a series of eighteen cases

Pierrart, J.; Bégué, Thierry; Mansat, Pierre

doi:10.1016/s0020-1383(15)70004-5

Cited by 47 publications

(34 citation statements)

References 15 publications

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“…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 …”

Section: Discussioncontrasting

confidence: 67%

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

Liu

et al. 2018

J Int Med Res

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SummaryObjectiveTo report the results of the surgical treatment of terrible triad injury with anteromedial coronoid fracture through a combined surgical approach.MethodsThis retrospective study evaluated data from patients who underwent surgery to repair terrible triad injuries and anteromedial coronoid fractures. Surgical treatment involved radial head repair or replacement, medial and lateral collateral ligament repair, and coronoid fracture fixation through combined approaches. Evaluations were performed using the Mayo Elbow Performance Score (MEPS) and anteroposterior and lateral radiographs of the elbow.ResultsTwenty-two patients (15 males, seven females; mean ± SD age, 47.5 ± 11.4 years) were enrolled in this study. Fracture union and concentric reduction of both the ulnotrochlear and radiocapitellar articulations were achieved in all patients. The mean ± SD follow-up was 31.6 ± 11.9 months. The mean ± SD arc of flexion–extension was 110.3° ± 26.3° and arc of forearm rotation was 139.5° ± 17.1°. The mean ± SD MEPS was 88.1 ± 12.2 points, with results classified as excellent in eight elbows, good in ten, and fair in four. Six patients had radiographic signs of post-traumatic arthritis. Three patients required secondary surgeries.ConclusionCombined surgical approaches can be considered for the treatment of terrible triad injuries in association with anteromedial coronoid fractures.

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Section: Discussioncontrasting

confidence: 67%

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

Liu

et al. 2018

J Int Med Res

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“…The terrible triad of the elbow (TTE) causes extensive damage to the ligaments and osseous structures, which causes acute elbow instability [ 6 , 12 , 16 , 17 , 19 ]. Almost all TTE patients need surgical treatment; however, although even the most experienced experts do their best to repair or rebuild injured structure, the clinical results are still not ideal [ 8 , 15 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is accepted that if the elbow joint immobilization persists for more than 2 weeks, the rate of elbow stiffness will increase greatly. A high rate of ankylosis after surgical repair of elbow injuries has been reported in numerous papers, especially in patients with TTE [ 10 – 12 ]. Anneluuk et al consider that the TTE patients receiving acute treatment (within 2 weeks after injury) have better outcomes than patients receiving subacute treatment (3 weeks or more after injury) [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Does Timing of Surgery Affect Treatment of the Terrible Triad of the Elbow?

Zhou

Lin

et al. 2018

Med Sci Monit

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BackgroundThis study investigated the influence of surgical timing on the treatment of terrible triad of the elbow (TTE).Material/MethodsAfter exclusion, 63 patients were enrolled in this study: 20 patients were classified into the emergency group (group A, within 24 h after injury), 26 into the early surgery group (group B, from 4 to 14 days after injury), and 17 into the delayed surgery group (group C, more than 14 days after injury). All patients underwent the same approach, and elbow motion and complication rates were recorded and compared.ResultFifty-eight patients were followed up (mean 20.5±1.9 months), and 5 patients had lost partial final data. At 1 month after the operation, elbow motion in group A was higher than in group B and group C (P<0.01); however, 3 or more months later, there was no distinct difference between group A and group B (P>0.05), while both group A and group B showed better outcomes than group C at all time points (P<0.05). Moreover, group A and group B had better higher elbow motion, MEPS, excellent and good rate than group C at the final clinical visit (all P<0.05). No postoperative pain or complication rate differences were found among the 3 groups except for elbow stiffness (2 in group A, 3 in group B, and 7 in group C) (P<0.05) which required reoperation to enhance elbow function.ConclusionsEmergency or early operation for TTE patients were more effective than delayed operation.

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“…However, others reported the use of a combined lateral and medial approaches. [ 5 , 7 , 8 ] The ideal surgical approach should be based on the mode and details of injury. We preferred a direct lateral or combined approach, which avoided the need for a large posterior flap while still having adequate exposure; albeit, a posterior approach allows both sides of the elbow to be treated with 1 incision.…”

Section: Discussionmentioning

confidence: 99%

“…Although this procedure has been shown to be effective, [ 3 , 4 , 7 ] some of the treatment aspects, such as the surgical approach and whether to treat the MCL and coronoid fracture, remain controversial. [ 2 – 8 ] The purpose of the present study was to investigate the efficacy of a modified standard protocol for the surgical treatment of terrible triad injuries of the elbow based on the mode and mechanism of injury, and also intraoperative findings.…”

Section: Introductionmentioning

confidence: 99%

Operative treatment of terrible triad of the elbow with a modified Pugh standard protocol

Liu

et al. 2018

Medicine

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The aim of the present study was to investigate the efficacy of the surgical treatment of terrible triad injuries of the elbow using a modified standard surgical approach, and treatment determined by the mode and mechanism of injury, and intraoperative findings.The study was a retrospective analysis of a prospective cohort of patients presenting with terrible triad injuries of the elbow, who underwent surgical treatment between July 2009 and January 2014. All patients were treated surgically according to a modified Pugh standard protocol. Elbow functional status and range of movements were evaluated at 3 months, 6 months, 1 year, and 2 years or more after surgery. Radiographic signs of post-traumatic arthritis were rated according to the Broberg and Morrey system.Our series included a final cohort of 29 males and 13 females with a mean age of 48.23 ± 10.95 years at the time of injury. The mean follow-up period was 30.47 ± 7.65 months. The mean flexion-extension arc was 107° ± 22°, and the average forearm rotation arc was 145° ± 14°. The mean Mayo Elbow Performance Score was 88 ± 10 points (range 55 to 100 points), with excellent results in 24 elbows, good results in 16, and poor results in 2. Functional results of the elbow improved significantly from 3 months postoperatively (P < .05), but tended to plateau from 1 year after surgery. Thirteen patients had radiographic signs of arthrosis (9 grade 1, 4 grade 2). Postoperative complications were local infection around the incision (n = 1), transient postoperative median nerve paralysis (n = 1), and postoperative posterior interosseous nerve paralysis (n = 1). Four patients required further surgery. Five patients had evidence of heterotopic ossification.Overall, we show that slight modifications to Pugh standard protocol for the surgical treatment of terrible triad injuries can lead to good to excellent results, although there were a good number of complications. The ideal surgical approach and treatment should be based on the mode and mechanism of injury, and intraoperative findings, and modifying the standard surgical treatment approach for terrible triad elbow injuries may be beneficial.

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Terrible triad of the elbow: treatment protocol and outcome in a series of eighteen cases

Cited by 47 publications

References 15 publications

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

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

Does Timing of Surgery Affect Treatment of the Terrible Triad of the Elbow?

Operative treatment of terrible triad of the elbow with a modified Pugh standard protocol

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