Terrible Triad of the Elbow—Role of the Coronoid Process: A Case Report

Seijas, Roberto; Joshi, Naresh; Hernandez, Arnaldo José; Catalán, Jaime; Flores, Xavier; Nieto, Julià Monreal

doi:10.1177/230949900501300314

Cited by 10 publications

(20 citation statements)

References 9 publications

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“…Furthermore, conservative treatment regimens have been previously reported to bare unsatisfactory results, given that fracture site prone to redislocation. [18] Patients undergoing surgical treatment through a combined posterior lateral and anteromedial approach, however, showed increased fracture healing rate, improved elbow functioning, and decreased incidence of complications. [13] Similarly, another research demonstrated that surgical treatment regimens for terrible triad of elbow joint, such as radial head arthroplasty, repairing the coronoid or the joint capsule, and repairing the lateral ligament complex of the elbow, accomplished good results in majority patients, which was independent from treatment for radial head fractures.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of efficacy for patients receiving surgical treatment following terrible triad of the elbow joint

Chen

Huang

2019

Medicine

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Background:This study aims to explore the efficacy of surgical and conservative treatment for elbow joint terrible triad, and evaluate related factors affecting surgical treatment efficacy.Methods:Patients with terrible triad of elbow joint (n = 165) were selected, among which 79 cases underwent conservative treatment (the control group) and 86 cases underwent surgical treatment (the experimental group). The range of flexion and extension, range of rotation and Mayo elbow performance score were recorded. In the experimental group, postoperation, according to the Mayo elbow performance score, patients were assigned into the effective group (72 cases) and ineffective group (14 cases). All patients were followed up regularly for 6 to 24 months. X-ray and computed tomography examination were used to examine anterior and posterior elbow joints preoperatively and postoperatively and the degree of arm rotation.Results:The range of flexion and extension, range of rotation and Mayo elbow performance score were found to be significantly higher in the experimental group after treatment compared to the experimental group before treatment and in the control group after treatment. Seven days after treatment, compared with the control group, the expressions of interleukin (IL)-6, C-reactive protein, IL-8, and tumor necrosis factor-α in serum decreased, and returned to almost near normal levels in the experimental group. Age, mean operative time, and postoperative immobilization time were significantly different between the effective and ineffective groups. The incidence of joint stiffness, heterotopic ossification, and ulnar nerve symptoms in the effective group were lower than those in the ineffective group. The postoperative immobilization time served a protective factor for the efficacy of surgical treatment of elbow joint terrible triad, while age served as a risk factor.Conclusion:The results indicated that surgical treatment regimens for elbow joint terrible triad exhibited better efficacy than conservative treatment regimens, and lower age and longer postoperative immobilization time serve as protective factors for surgical treatment efficacy.

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Section: Discussionmentioning

confidence: 99%

Risk factors of efficacy for patients receiving surgical treatment following terrible triad of the elbow joint

Chen

Huang

2019

Medicine

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“…Coronoid fractures that are not amenable to fixation (because of size, comminution, or delay in treatment) may be reconstructed or treated non-operatively [3, 6-8, 11, 12, 14, 16, 19, 23]. Seijas et al, however, reported a case of persistent ulnohumeral subluxation requiring joint transfixation after excision of coronoid fragments in a terrible triad injury [20]. Other authors recommend against excision of bone fragments as they may be useful for callus formation [9].…”

Section: Discussionmentioning

confidence: 99%

Coronoid Fixation Using Suture Anchors

Clarke

Lee

Raphael

2008

Hand (New York, N,Y.)

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Fractures of the coronoid process of the ulna generally occur in relatively high-energy injuries and are commonly associated with injuries to other structures around the elbow. Damage to the coronoid process in addition to other elbow structures may complicate treatment. Several approaches have been used in the management of coronoid process fractures. This paper reports a method of coronoid process fracture fixation using suture anchors.

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“…In certain circumstances (e.g. low-energy falls from standing height and high energy accidents), posterior dislocation of the elbow may appear combined with fractures of the coronoid process and radial head in a complex injury termed as "terrible triad" (Seijas et al, 2005;Bohn et al, 2014). Isolated coronoid fractures, such as those caused by avulsion of the brachialis muscle, are rare (Gadgil et al, 2002) but have been reported in athletes, such as baseball pitchers (Akagi et al, 2000).…”

Section: Differential Diagnosismentioning

confidence: 99%

“…The latter bone changes were not observed in the case in discussion. In fact, the management of large fractures of the coronoid process constitutes a challenge for orthopaedic surgeons, sometimes requiring bone and soft tissues reconstruction (Ring, 2006;Seijas et al, 2005;Manidakis et al, 2012). It is highly possible that the severity of the coronoid fracture and the presence of trauma complications have led to some degree of disability in the right upper limb with a negative impact on the individual's daily activities.…”

Section: Differential Diagnosismentioning

confidence: 99%

An unusual coronoid fracture in a fragment of ulna recovered from the Prehistoric site of Buraca da Moira Rock Shelter (Boa Vista, Leiria)

et al. 2019

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In 2015, several disarticulated human skeletal remains were identified in the top layers of the prehistoric site of Buraca da Moira Rock Shelter (Boa Vista, Leiria), during the archaeological excavation carried out under the scope of the EcoPLis — Human Occupations in the Pleistocene Ecotones of the River Lis project. The recovery of chert, constiquartz and quartzite blanks, a schist plate, as well as adornments in bone and shell indicates a Late Neolithic-Chalcolithic chronology. The disarticulated human assemblage, composed of a total of 129 bone and tooth fragments, allowed the estimation of a minimum number of six individuals. Among the remains recovered, an upper portion of an adult right ulna lacking the coronoid process was identified. Replacing it, a semi-oval groovewith smooth contours and exposing some trabecular bone was observed. The location, type of bone change, and the observed signs of bone healing are consistent with an uncommon trauma: a fracture of the coronoid process. In the differential diagnosis, both postmortem changes and developmental disturbances were considered but later excluded. The mechanisms that underlie the bone changes are discussed in light of the clinical and paleopathological literature.

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Terrible Triad of the Elbow—Role of the Coronoid Process: A Case Report

Cited by 10 publications

References 9 publications

Risk factors of efficacy for patients receiving surgical treatment following terrible triad of the elbow joint

Risk factors of efficacy for patients receiving surgical treatment following terrible triad of the elbow joint

Coronoid Fixation Using Suture Anchors

An unusual coronoid fracture in a fragment of ulna recovered from the Prehistoric site of Buraca da Moira Rock Shelter (Boa Vista, Leiria)

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