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Terrible triad injury of the elbow: a historical perspective

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Abstract

Purpose

The aims of this study are to summarize (1) the history of terrible triad injury (TTi) treatment and (2) the clinical and biomechanical data that engendered its evolution.

Methods

A literature search was performed using five electronic databases. Results were discussed as a chronologic review of the relevant literature between 1920 and 2022.

Results

In 1962, Osborne was the first to describe a link between elbow dislocation, radial head fracture, and lateral collateral ligament complex injury via a novel mechanism: posterolateral rotatory instability (PLRI). Given that untreated elbow instability leads to post-traumatic osteoarthritis (PTOA), there has been increasing interest in elbow biomechanics since the 1980s. Data from studies in that period revolutionized the approach to elbow instability. The authors demonstrated that TTi could occur via a PLRI mechanism with a disruption of the lateral collateral ulnar ligament and a functionally competent anterior medial collateral ligament (aMCL). Since the 1990s, due to the difficulty in identifying its pathoanatomic features, some began to speculate about a sequence of injuries and mechanisms leading to TTi. However, the clinical literature has largely been unable to reproduce in vitro findings describing the pathomechanics of TTi. Some aspects of treatment remain controversial including systematic coronoid and aMCL repair.

Conclusion

Despite a growing body of biomechanics data, there is no widely accepted surgical protocol for the treatment of TTi. Functional outcomes among patients have greatly improved. Better diagnosis and treatment of infra-clinical instability after a TTi may be an important stepping stone to prevent the onset of moderate/severe PTOA.

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Funding

Figures 1, 2, and 3 of the present study were funded by Newclip Technics France.

Author information

Authors and Affiliations

  1. Department of Orthopedics and Traumatology, Hôpital Lapeyronie, Montpelier, France

    Olivier Bozon

  2. Department of Orthopedics and Traumatology, Hôpital Dupuytren, Limoges, France

    Sacha Chrosciany

  3. Department of Orthopedics and Traumatology, Hôpital Pontchaillou, Rennes, France

    Marie Loisel

  4. Department of Orthopedics and Traumatology, Hôpital Cavale Blanche, Brest, France

    Arthur Dellestable

  5. Department of Orthopedics and Traumatology, Hôpital Côte de Nacre, Caen, France

    Laura Gubbiotti

  6. Department of Orthopedics and Traumatology, CHU, Angers, France

    Raphaëlle Dumartinet-Gibaud

  7. Department of Orthopedics and Traumatology, Hôpital Charles Nicolle, Rouen, France

    Elise Obrecht

  8. Department of Orthopedics, Mayo Clinic, Rochester, MN, USA

    Meagan Tibbo

  9. Department of Orthopedics and Traumatology, Hôpital Trousseau, Tours, France

    Clara Sos

  10. Department of Orthopedics and Traumatology, Hôpital Pellegrin, Place Amélie Raba-Léon, 33000, Bordeaux, France

    Pierre Laumonerie

Authors
  1. Olivier Bozon
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  2. Sacha Chrosciany
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  3. Marie Loisel
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  4. Arthur Dellestable
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  5. Laura Gubbiotti
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  6. Raphaëlle Dumartinet-Gibaud
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  7. Elise Obrecht
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  8. Meagan Tibbo
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  9. Clara Sos
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  10. Pierre Laumonerie
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Contributions

• O. Bozon: conception and design, critical revisions, manuscript review

• S. Chrosciany: data acquisition, manuscript review.

• M. Loisel: data acquisition, manuscript review.

• Dellestable: data acquisition, manuscript review.

• L. Gubbiotti: data acquisition, manuscript review.

• R. Dumartinet-Gibaud: data acquisition, manuscript review.

• E. Obrecht: data acquisition, manuscript review.

• ME. Tibbo: data acquisition, manuscript review

• Sos: data acquisition, manuscript review.

• P. Laumonerie: conception and design, critical revisions, manuscript review, approved final version of paper, administration, study supervision

Corresponding author

Correspondence to Pierre Laumonerie.

Ethics declarations

Ethics approval and consent to participate

This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent was not needed for this literature review.

Conflict of interest

The authors declare no competing interests.

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Disclaimer None of the authors (Bozon Olivier, Chrosciany Sacha, Loisel Marie, Dellestable Arthur, Gubbiotti Laura, Dumartinet-Gibaud Raphaëlle, Obrecht Elise, Tibbo Meagan, Sos Clara, Laumonerie Pierre), or any member of their family, have received any financial remu-neration related to the subject of the article.

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Bozon, O., Chrosciany, S., Loisel, M. et al. Terrible triad injury of the elbow: a historical perspective. International Orthopaedics (SICOT) 46, 2265–2272 (2022). https://doi.org/10.1007/s00264-022-05472-4

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  • DOI: https://doi.org/10.1007/s00264-022-05472-4

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