Abstract
Background
The objective was to analyze the long-term clinical outcome of terrible triad injury of the elbow following surgical intervention with a single lateral approach.
Method
We treated twenty-five patients with terrible triad injury of the elbow from July 1, 2017, to June 30, 2020, and performed post hoc analysis. All patients underwent standardized surgery which entailed: plate fixation for the ulnar coronoid process, fixation or replacement of the radial head, and repair of the lateral ligament but not the medial collateral ligament.
Results
We followed up each patient for an average of 22.9 months (range, 12 to 36 months) after surgery. Patients had an average angle scope of elbow flexion and extension that ranged from 8° to 120°. Average pronation of the elbow was 75° (range, 10°–85°), and average supination was 72° (range, 25°–80°). Patient-reported outcome measures were excellent: the DASH and Mayo elbow performance score (MEPS) were 96%. We were unable to follow-up one patient (4%). Among the remaining 24 patients, one patient (4%) presented with heterotopic ossification and stiffness following arthrolysis in the elbow one year after the initial surgery. We did not observe any joint dislocation, subluxation, or joint instability in the elbow after surgery.
Discussion
The single lateral approach, a sequential surgery for terrible triad injury of the elbow, can improve initial stability of the elbow. Patients are able to perform rehabilitative exercises sooner in their recovery, which helps to reduce stiffness. Heterotopic ossification is also reduced.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Chen HW, Liu GD, Ou S, Fei J, Zhao GS, Wu LJ, Pan J (2015) Operative treatment of terrible triad of the elbow via posterolateral and anteromedial approaches. PLoS One 10:e0124821
Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG (2014) Terrible triad injuries of the elbow: does the coronoid always need to be fixed. Clin Orthop Relat Res 472:2084–2091
Morrey BF, Adams RA (1992) Semiconstrained arthroplasty for the treatment of rheumatoid arthritis of the elbow. J Bone Joint Surg Am 74:479–490
Ring D, Jupiter JB, Zilberfarb J (2002) Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am 84:547–551
Forthman C, Henket M, Ring DC (2007) Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament. J Hand Surg Am 32:1200–1209
Cui HM, Yu YL, He Y, Cheng Y, Liu JZ, Zheng W, Chen S, Fan CY (2018) Management of elbow stiffness after postoperative treatment of terrible triad elbow injury: maintaining mobility and stability using a combined protocol. Int Orthop 42:609–618
Barfield WR, Holmes RE, Hartsock LA (2017) Heterotopic ossification in trauma. Orthop Clin North Am 48:35–46
Shukla DR, Pillai G, McAnany S, Hausman M, Parsons BO (2015) Heterotopic ossification formation after fracture-dislocations of the elbow. J Shoulder Elb Surg 24:333–338
Ring D, Horst TA (2015) Coronoid fractures. J Orthop Trauma 29:437–440
Bohn K, Ipaktchi K, Livermore M, Cao J, Banegas R (2014) Current treatment concepts for "terrible triad" injuries of the elbow. Orthopedics 37:831–837
Mathew PK, Athwal GS, King GJ (2009) Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg 17:137–151
Chang JK, Li CJ, Liao HJ, Wang CK, Wang GJ, Ho ML (2009) Anti-inflammatory drugs suppress proliferation and induce apoptosis through altering expressions of cell cycle regulators and pro-apoptotic factors in cultured human osteoblasts. Toxicology 258:148–156
Zhang C, Zhong B, Luo CF (2014) Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People's Hospital. Injury 45:942–948
Zhou C, Xu J, Lin J, Lin R, Chen K, Kong J, Feng Y, Shui X (2018) Comparison of a single approach versus double approaches for the treatment of terrible triad of elbow-a retrospective study. Int J Surg 51:49–55
Toros T, Ozaksar K, Sügün TS, Kayalar M, Bal E, Ada S (2012) The effect of medial side repair in terrible triad injury of the elbow. Acta Orthop Traumatol Turc 46:96–101
Garrigues GE, Wray WH 3rd, Lindenhovius AL, Ring DC, Ruch DS (2011) Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg Am 93:1873–1881
Chemama B, Bonnevialle N, Peter O, Mansat P, Bonnevialle P (2010) Terrible triad injury of the elbow: how to improve outcomes. Orthop Traumatol Surg Res 96:147–154
Morrey BF, An KN (2005) Stability of the elbow: osseous constraints. J Shoulder Elb Surg 14:174S–178S
Pugh DM, Wild LM, Schemitsch EH, King GJ, McKee MD (2004) Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am 86:1122–1130
Gupta A, Barei D, Khwaja A, Beingessner D (2014) Single-staged treatment using a standardized protocol results in functional motion in the majority of patients with a terrible triad elbow injury. Clin Orthop Relat Res 472:2075–2083
Xiao K, Zhang J, Li T, Dong YL, Weng XS (2015) Anatomy, definition, and treatment of the "terrible triad of the elbow" and contemplation of the rationality of this designation. Orthop Surg 7:13–18
Acknowledgments
The authors would like to thank all the reviewers and patients involved in this study who participated in the review patients involved in this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hou, F., Liang, X., Fan, W. et al. Analysis of twenty-five cases of terrible triad injury of the elbow surgically treated with a single lateral approach. International Orthopaedics (SICOT) 45, 241–246 (2021). https://doi.org/10.1007/s00264-020-04891-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-020-04891-5