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Management of elbow stiffness after postoperative treatment of terrible triad elbow injury: maintaining mobility and stability using a combined protocol

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Abstract

Purposes

The purpose of this study was to evaluate the results of our protocol that include the restoration of mobility using open release combined with external fixation and stability using ligament repair, to determine the optimal timing of surgery, and to investigate whether resection and replacement of the radial head are associated with different outcomes.

Methods

Twenty-six patients with elbow stiffness after operation of terrible triad injury of the elbow were treated with our protocol. We assessed the optimal timing of the operation by comparing outcomes between the early treatment group and the delayed treatment group. The comparison was performed to investigate whether the results differed between resection and replacement of the radial head. Stability of the elbow, range of motion (ROM), Mayo Elbow Performance Score (MEPS), and complications were assessed for each patient.

Results

The mean interval from the initial surgery to the index procedure was 13 months, and the mean follow-up period was 29 months. The MEPS increased from a mean of 65 points to 94 points. Twenty-five of 26 patients achieved stability of the elbow, and all patients achieved functional ROM. There were no significant differences between the two subgroups with respect to ROM and stability of the elbow.

Conclusion

Our protocol can restore mobility and stability. Resection and replacement of the radial head are both feasible using this protocol. Lastly, the timing of the surgery was not very rigorous, and the surgical delay may be insignificant.

Level of evidence:

Level IV; Case Series; Treatment Study.

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Funding

The funding source did not play a role in our investigation.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai, 200233, China

    Hao-min Cui, Ya-ling Yu, Yuan Cheng, Jia-zhi Liu, Wei Zheng, Shuai Chen & Cun-yi Fan

  2. Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100010, China

    Yu He

  3. Taishan Medical University, 619 Changcheng Road, Taian, 271016, China

    Jia-zhi Liu

Authors
  1. Hao-min Cui
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  2. Ya-ling Yu
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  3. Yu He
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  4. Yuan Cheng
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  5. Jia-zhi Liu
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  6. Wei Zheng
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  7. Shuai Chen
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  8. Cun-yi Fan
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Corresponding author

Correspondence to Cun-yi Fan.

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Additional information

Hao-min Cui, Ya-ling Yu, and Yu He are co-first authors.

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Cui, Hm., Yu, Yl., He, Y. et al. Management of elbow stiffness after postoperative treatment of terrible triad elbow injury: maintaining mobility and stability using a combined protocol. International Orthopaedics (SICOT) 42, 609–618 (2018). https://doi.org/10.1007/s00264-017-3721-x

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  • DOI: https://doi.org/10.1007/s00264-017-3721-x

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