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Terrible Triad Injuries

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Acute Elbow Trauma

Part of the book series: Strategies in Fracture Treatments ((SFT))

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Abstract

The terrible triad injury represents a rare but severe injury to the elbow joint. It consists of a posterior elbow dislocation with concomitant fractures of the radial head and the coronoid process, and is usually caused by a fall on the outstretched hand. Following closed reduction, joint stability should be evaluated under fluoroscopy whenever possible. Redislocation under varus/valgus stress or at more than 30° of flexion is suggestive of gross instability. Aside from standard radiographs, CT scans with 3D reconstructions are mandatory for detailed assessment of this injury.

In the rare case of a stable flexion arc, joint congruity following reduction as well as small, minimally displaced coronoid and radial head fractures without block of motion, non-operative treatment with a close follow-up can be attempted. In most cases however, surgical therapy is indicated. Clinical outcomes following terrible triad injuries have significantly improved due to the introduction of a standardized protocol consisting of radial head fixation/replacement, coronoid fixation/reconstruction, lateral collateral ligament repair and – if necessary – additional medial collateral ligament repair and/or use of a hinged external fixator. While the majority of patients show satisfying clinical results, complications remain frequent with elbow stiffness representing the most common cause for revision surgery.

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany

    Michael Hackl & Lars Peter Müller

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  1. Michael Hackl
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  2. Lars Peter Müller
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Correspondence to Michael Hackl .

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Editors and Affiliations

  1. Department of Trauma Surgery, Technical University Munich Klinikum rechts der Isar, Munich, Germany

    Peter Biberthaler

  2. Department of Orthopaedic Sports Medicine, Technical University Munich Klinikum rechts der Isar, Munich, Germany

    Sebastian Siebenlist

  3. St. Michael’s Hospital, Toronto, ON, Canada

    James P. Waddell

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Hackl, M., Müller, L.P. (2019). Terrible Triad Injuries. In: Biberthaler, P., Siebenlist, S., Waddell, J. (eds) Acute Elbow Trauma. Strategies in Fracture Treatments. Springer, Cham. https://doi.org/10.1007/978-3-319-97850-5_7

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  • DOI: https://doi.org/10.1007/978-3-319-97850-5_7

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