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Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome

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Abstract

Introduction

The combination of posterior elbow dislocation, radial head fracture, and coronoid fracture has been named “terrible triad” as this injury is difficult to treat and yield poor outcomes. Some studies compared the results of radial head fixation to replacement in isolated radial head fractures, very few reports have tried to compare both treatment modalities in the setting of a terrible triad injury.

The aim of this study was to compare the functional outcome of radial head fixation vs replacement in terrible triad injuries of the elbow.

Methods

A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from April 2016 to April 2019.

A total of 30 patients with terrible triad injury of the elbow were enrolled. The primary outcome was the Quick Disability of Arm, Shoulder and Hand (Quick-DASH) at 1 year. The secondary outcomes were to report the Mayo Elbow Performance Score (MEPS) at 1 year and elbow range of motion.

Results

At final follow up for each patient (13.4 ± 1.2 months) The Quick-DASH score at 1 year for fixation group was 5 ± 2.3, for the replacement group it was 7.1 ± 7.1. The MEPS at 1 year for fixation group was 93.6 ± 8.4, for the replacement group it was 90.9 ± 9.4.

Loss of elbow extension at 1 year for fixation group was 17.1° ± 10.7°, for replacement group it was 18.75° ± 11.5°.

Conclusion

A systematic approach to address the bony and soft tissue components of terrible triad elbow injury is crucial to obtain satisfactory outcome. Our study shows that radial head repair and replacement, in the setting of terrible triad injury, yields comparable results.

Level of evidence

Level II, Therapeutic study.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, 11559, Egypt

    Ahmed Afifi, Ahmed M. Lymona & Sherif Galal

  2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Sherif Galal

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  1. Ahmed Afifi
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  2. Ahmed M. Lymona
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  3. Sherif Galal
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Correspondence to Sherif Galal.

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The author, their immediate family, and any research foundation with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Afifi, A., Lymona, A.M. & Galal, S. Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome. JOIO 54 (Suppl 2), 254–259 (2020). https://doi.org/10.1007/s43465-020-00090-x

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  • DOI: https://doi.org/10.1007/s43465-020-00090-x

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