The “Terrible Triad” of the Elbow

Pugh, David M.; McKee, Michael D.

doi:10.1097/00130911-200203000-00005

Cited by 66 publications

(43 citation statements)

References 15 publications

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“…With regard to patient complaints of stiffness, this also was seen quite frequently throughout the course of care but again most of them had achieved a functional arc of motion. This reinforces the notion that a ''normal'' elbow is rarely achieved but that reasonable results within functional ROMs are attainable [22]. Patients can be counseled that even several months into postoperative recovery, stiffness may persist, but a good functional outcome that does not require further surgery is possible in the majority of cases.…”

Section: Discussionsupporting

confidence: 74%

“…Other published results similarly demonstrate an average flexionextension arc of 100°to 119°and a supination-pronation arc of 128°to 141° [9,11,17,23,31]. The functional ROM of the elbow for most activities of daily living is thought to be 100°of flexion-extension and 100°of supination-pronation [22] and in a large majority of patients, this can adequately be achieved with a single surgical intervention.…”

Section: Discussionmentioning

confidence: 92%

“…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%

“…Previous reports show that most common complications with these injuries include stiffness, instability, heterotopic ossification, and ulnar neuropathy [11,18,[21][22][23]25] (15%-25% [22]). The rate of secondary surgery in this study (26%) compares similarly to other studies, which publish a secondary surgical rate of 15% to 25% [9,11,17,22,23]. Other studies have noted ulnar neuritis requiring secondary ulnar nerve decompression at similar rates as well [9,11,17], although prophylactic release during the index procedure was variably performed.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…The reason for this might be that Bado II lesions are frequently associated with intra-articular fractures of the ulna, radial head fractures, or coronoid fractures [43]. Givon et al [7] reported that Bado Type I fractures had a worse outcome than other types.…”

Section: Resultsmentioning

confidence: 99%

Monteggia and Monteggia-like-lesions: Classification, Indication, and Techniques in Operative Treatment

Josten

Freitag

2008

Eur J Trauma Emerg Surg

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Monteggia fractures consist of an ulna fracture accompanied by radial head dislocation. Such fractures are easily overlooked due to the prominence of the ulna fracture. Earlier studies have reported on the results of treating Monteggia fractures in children and adults even though this type of fracture is different in these two patient populations. As such they should be considered as separate entities due to the different injury pattern, the prognosis, and the preferred method of treatment. For a good postoperative result, an early detection of the Monteggia dislocation, an efficient operative treatment of the ulna fracture, and reposition of the radial head are essential. The goal of reconstruction is an early mobilization within a stable arc of motion. Here, we provide an overview of the classification of Monteggia fractures, the mechanism of injury, and treatment options with the aim of providing sufficient information to reduce the possibility of underestimating forearm injuries in adults.

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