Analysis of radial head and coronoid process fractures in terrible triad of elbow

  • Shaoliang Li
  • Xu Li
  • Yi LuEmail author
Original Article • ELBOW - FRACTURES



To describe the morphological characteristics of radial head and coronoid fractures and evaluate the relationship of two fracture patterns in terrible triad.


Distributions of all types of radial head and coronoid fractures according to the Mason, Regan–Morrey, and O’Driscoll classifications were firstly described by reviewing radiographs and computed tomography scans in 92 consecutive terrible triads. Then, distributions of all combinations of radial head and coronoid fractures were reported. Correlation analysis between severity of radial head and coronoid fractures was finally performed.


In radial head fractures, Mason 2 accounted for 68%, Mason 3 accounted for 32%, and no Mason 1 was found. In coronoid fractures, there were 29 type 1, 44 type 2, and 19 type 3 in Regan–Morrey classification and 72 type 1, one type 2, and 19 type 3 in O’Driscoll classification. There were 28 M2R2, 23 M2R1, 16 M3R2, 12 M2R3, seven M3R3, and six M3R1 in combined Mason and Regan–Morrey type. There were 53 M2O1, 19 M3O1, 10 M3O3, nine M2O3, and one M2O2 in combined Mason and O’Driscoll type. A weak correlation was found between radial head and coronoid fractures.


In terrible triad injuries, the most common type of radial head fracture is Mason 2, while the most common type of coronoid fracture is Regan–Morrey type 2 or O’Driscoll type 1. In combinations of two fracture patterns, M2R2 or M2O1 is the most common. Severity of radial head fractures is weakly correlated with coronoid fractures.


Terrible triad Coronoid Radial head Fractures 


Compliance with ethical standards

Conflict of interest

Authors Shaoliang Li, Xu Li, and Yi Lu declare that they have no conflict of interest.

Ethical approval

The study complies with the current laws of the country.


  1. 1.
    Hotchkiss RN (1996) Fractures and dislocations of the elbow. In: Rockwood CA, Green DP, Bucholz RW, Heckman JD (eds) Rockwood and Green’s fractures in adults, 4th edn. Lippincott-Raven, Philadelphia, pp 929–1024Google Scholar
  2. 2.
    Josefsson PO, Gentz CF, Johnell O, Wendeberg B (1989) Dislocations of the elbow and intraarticular fractures. Clin Orthop Relat Res 246:126–130Google Scholar
  3. 3.
    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 84:547–551CrossRefGoogle Scholar
  4. 4.
    Matzon JL, Widmer BJ, Draganich LF, Mass DP, Phillips CS (2006) Anatomy of the coronoid process. J Hand Surg Am 31(8):1272–1278CrossRefGoogle Scholar
  5. 5.
    Adams JE, Sanchez-Sotelo J, Kallina CF 4th, Morrey BF, Steinmann SP (2012) Fractures of the coronoid: morphology based upon computer tomography scanning. J Shoulder Elbow Surg 21(6):782–788. CrossRefGoogle Scholar
  6. 6.
    Manidakis N, Sperelakis I, Hackney R, Kontakis G (2012) Fractures of the ulnar coronoid process. Injury 43(7):989–998. CrossRefGoogle Scholar
  7. 7.
    Mason ML (1954) Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg 42:123–132CrossRefGoogle Scholar
  8. 8.
    Regan W, Morrey B (1989) Fractures of the coronoid process of the ulna. J Bone Joint Surg Am 71:1348–1354CrossRefGoogle Scholar
  9. 9.
    Schneeberger AG, Sadowski MM, Jacob HA (2004) Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am 86:975–982CrossRefGoogle Scholar
  10. 10.
    O’Driscoll SW, Jupiter JB, Cohen MS, Ring D, McKee MD (2003) Difficult elbow fractures: pearls and pitfalls. Instr Course Lect 52:113–134Google Scholar
  11. 11.
    Doornberg JN, van Duijn J, Ring D (2006) Coronoid fracture height in terrible-triad injuries. J Hand Surg Am 31(5):794–797. CrossRefGoogle Scholar
  12. 12.
    Yoon A, Athwal GS, Faber KJ, King GJ (2012) Radial head fractures. J Hand Surg Am 37(12):2626–2634. CrossRefGoogle Scholar
  13. 13.
    Pike JM, Athwal GS, Faber KJ, King GJ (2009) Radial head fractures: an update. J Hand Surg Am 34(3):557–565. CrossRefGoogle Scholar
  14. 14.
    Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37(8):691–697. CrossRefGoogle Scholar
  15. 15.
    Kaas L, van Riet RP, Vroemen JP, Eygendaal D (2010) The epidemiology of radial head fractures. J Shoulder Elbow Surg 19(4):520–523. CrossRefGoogle Scholar
  16. 16.
    Duckworth AD, Clement ND, Jenkins PJ, Aitken SA, Court-Brown CM, McQueen MM (2012) The epidemiology of radial head and neck fractures. J Hand Surg Am 37(1):112–119. CrossRefGoogle Scholar
  17. 17.
    Court-Brown CM, McQueen MM, Tornetta P (2006) Proximal forearm fractures and elbow dislocations. In: Court-Brown C, McQueen MM, Tornetta P (eds) Orthopaedic surgery essentials: trauma, 1st edn. Lippincott Williams & Wilkins, Philadelphia, pp 124–140Google Scholar
  18. 18.
    Doornberg JN, Ring D (2006) Coronoid fracture patterns. J Hand Surg Am 31(1):45–52. CrossRefGoogle Scholar
  19. 19.
    Hull JR, Owen JR, Fern SE, Wayne JS, Boardman ND III (2005) Role of the coronoid process in varus osteoarticular stability of the elbow. J Shoulder Elbow Surg 14(4):441–446. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Beijing Ji Shui Tan HospitalBeijingChina

Personalised recommendations