Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People's Hospital. The “terrible triad injury” of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture. Among the variety of disease designations, the terrible triad of the elbow looms large and is eye‐catching... Anatomy. The Elbow Terrible Triad - Surgical Treatment. If the elbow is unstable after repair of the coronoid, radiohumeral joint and LCL then the MCL can be repaired. Preoperative lateral (A) and anteroposterior (AP) (B) radiographs show a Mason type II radial head fracture, an O’Driscoll anteromedial subtype 3 coronoid fracture, and dislocation of the elbow joint. The syndrome of “terrible triad of the elbow”, which was first described by Hotchkiss in 1996 1 , is a severe pattern of elbow fracture‐dislocation injury that consists of posterior dislocation of the elbow associated with fractures of the radial head and the coronoid process of the ulna. [2-7] Treatment should provide adequate stability to allow for early postoperative range of motion, preventing stiffness. The terrible triad of the elbow is characterized by great potential for joint instability and an unfavorable prognosis.1, 5 Surgical treatment is the therapy of choice in the vast majority of cases, with the aims of restoration of the anatomy and early mobility. Postoperative lateral (C) and AP (D) radiographs show concentric reduction of both the ulnotrochlear and radiocapitellar articulations, with no evidence of elbow instability at the 2-year follow-up. Clin Orthop Relat Res 472 (2014): 2075-2083. Preoperative lateral radiograph (A) and three-dimensional computed tomography (B) images show a Mason type II radial head fracture and an O’Driscoll anteromedial subtype 2 comminuted coronoid fracture after closed reduction of elbow dislocation. [Operative treatment of terrible triad injury of the elbow : Open reduction and internal fixation]. Our review had indicated that patients with terrible triad injuries undergo arthroplasty replacement have better clinical outcomes and fewer post-surgery complications than those received the repair surgery. © 2020 Elsevier Masson SAS. Injury. Keywords: Surgeons performed fixation of the radial head fracture and repair of the lateral collateral ligament through a lateral approach and fixation of the coronoid fracture through an anteromedial approach. Joaquin Sanchez-Sotelo. Surgical treatment for terrible triad injuries of the elbow (defined as elbow dislocations with concomitant fractures of the radial head and coronoid) remains a challenging clinical problem. The goal of treatment for terrible triad injuries is restoring the bony anatomy and reconstructing the ligamentous restraints of the elbow to provide enough stability for early elbow … Abstract: Operative treatment for complex elbow injuries has evolved. An ACL surgery is common and the meniscus can be treated during the surgery as well. Epub 2014 Jan 10. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Radial head replacement might be a more effective treatment approach with good clinical outcomes for patients with a terrible triad of the elbow. Module. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach Intervals: 1.2.1. McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ. Intervals: 1.2.1. 4 and 5). Injury 2015; 46 (Suppl 8): S68–S76.  |  Login. -, Pugh DM, Wild LM, Schemitsch EH, et al. Use of Mother-Child Screws in the Treatment of Coronoid Fractures in Terrible Triad Injury of the Elbow. Liu G, Hu J, Ma W, Li M, Xu R, Pan Z. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach. Click here to Login. Module. Operative treatment: 1. USA.gov. Oper Orthop Traumatol. Diagnosis. Conclusions: Our review had indicated that patients with terrible triad injuries undergo arthroplasty replacement have better clinical outcomes and fewer post-surgery complications than those received the repair surgery. terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation. 2020 Jul;8(3):207-208. doi: 10.30476/BEAT.2020.86013. Clin Orthop Relat Res. J Bone Joint Surg Am 2004; 86: 1122–1130. An understanding of the specific anatomy of these structures is paramount to the successful treatment of terrible triad injuries. Please enable it to take advantage of the complete set of features! dislocation is a common injury, its treatment has been traditionally associated with unsatisfactory outcomes and high complication rates [1–5]. Epub 2017 Mar 17. Preoperative anteroposterior (AP) radiograph (A) and three-dimensional computed tomography (B) images show a Mason type III radial head fracture and an O’Driscoll anteromedial subtype 1 coronoid fracture. Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). 1.1.2. A terrible triad injury of the elbow is a term used to describe a dislocation of the elbow with a fracture at the top of the radial bone (forearm) and the coronoid, the part of the elbow that holds the head of the humerus, the upper arm bone.Because of the extent of the injury, the usual treatment is open surgery. Our surgical procedure includes fixation or replacement of the radial head and repair of the ruptured This type of elbow injury is typically due to low or high energy falls onto an … The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. Related Content AUTOPLAY ON. The elbow is prone to stiffness, as such operative stabilization of complex injuries is imperative to allow for early mobilization. Operative treatment: 1. The elbow consists of bones, ligaments, tendons, and muscles that interact to allow for a stable, pain-free arc of motion. Schematic illustration showing a fracture of the anteromedial facet of the coronoid extending to involve the tip of the coronoid process (fracture fragment indicated by dotted lines). Acta Chir Orthop Traumatol Cech. dislocation is a common injury, its treatment has been traditionally associated with unsatisfactory outcomes and high complication rates [1–5]. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications … Prevention of these severe complications requires initial understanding of the lesion mechanism and precise analysis of all lesions. Approach: 1.1. Most repairs can be done from the lateral side. 2017 Apr;29(2):125-137. doi: 10.1007/s00064-017-0489-5. The aims of the present paper were to summarize the anatomic and pathophysiological bases, highlight the crucial importance of the humeroradial column and lateral collateral ligament, and to determine the importance of the coronoid process. The treatment of terrible triad injuries of the elbow continues to evolve. Additionally, it restores the lateral column of the elbow, acting to tension the repaired lateral ligaments resisting varus and posterolateral rotatory instability. Surgery is the treatment of choice as closed reduction is usually insufficient, as seen in this case. The goal of treatment of terrible triad injuries is to restore the bony and ligamentous restraints of the elbow to provide elbow stability. 20.1 (a–f) Complex elbow instability (terrible triad). Login to view comments. The purpose of treatment in the terrible triad injury is to restore the congruency of the elbow joint, its stability and an optimal ROM. Introduction. It is a complex trauma, associating severe bone and ligament lesions, with high more-or-less long-term risk of residual instability, stiffness, pain and osteoarthritis. During the last 20 years, pathologic, biomechanical and clinical knowledge has greatly progressed. COVID-19 is an emerging, rapidly evolving situation. ORIF of Distal Humerus Fractures 07:51. To report the results of the surgical treatment of terrible triad injury with anteromedial coronoid fracture through a combined surgical approach. The anteromedial coronoid fracture was fixed with K-wires and suture anchors through an anteromedial approach. An ACL surgery is common and the meniscus can be treated during the surgery as well. For this reason, it has been called the “terrible triad injury” of the elbow [3] Terrible triad injuries can lead to pain, recurrent instability, sti ness, and posttraumatic 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. Select Management. The short-term and long term results are historically poor, with a … Authors of section Editors. Separate medial and lateral incisions; Medial approach will be required if a large, repairable radial head is in the way. The purpose of treatment in the terrible triad injury is to restore the congruency of the elbow joint, its stability and an optimal ROM. This objective remains a challenge for surgeons due to the complexity of the lesion.5 treatment of the “terrible triad of the elbow”. ORIF of Distal Humerus Fractures 07:51. If plain radiographs are inconclusive or there is diagnostic uncertainty, further imaging with magnetic resonance imaging and CT are important [ 4 ]. 2005 Mar;87 Suppl 1(Pt 1):22-32. doi: 10.2106/JBJS.D.02933. Clipboard, Search History, and several other advanced features are temporarily unavailable. Specialty. (1) Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head. Meena MK, Singh K, Meena S, Kumbhare C, Chouhan D. Bull Emerg Trauma. Conservative treatment was attempted (due to the patient’s general status). should instability persist after addressing the radial head and the LCL complex in the presence of a small coronoid fracture, the next best step is MCL reconstruction. We help you select the appropriate treatment of Terrible triad located in our module on Proximal forearm. Specialty. Elbow; anteromedial facet of coronoid; fracture; terrible triad. Fracture-dislocation of the elbow functional outcome following treatment with a standardized protocol. Algorithm for surgical treatment of terrible triad elbow injuries. The goal of surgical treatment of the terrible triad of the elbow is the restoration of humeroulnar and humeroradial stability, thus facilitating the early onset of elbow movement in the postoperative period in order to reduce the probability of long-term joint dysfunction and stiffness. 2014 Jul;472(7):2084-91. doi: 10.1007/s11999-014-3471-7. All terrible triad injuries require surgical repair. The combination of elbow dislocation with both radial head and coronoid process fracture is notoriously challenging to treat and, as such, has been termed ‘‘terrible triad’’ injury of the elbow (TTIE) [1]. 11 Bull NYU Hosp Jt Dis 2007; 65: 263–270. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. Single- staged treatment using a standardized protocol results in functional motion in the majority of patients with a terrible triad elbow injury. Login. HHS 2020 Jul;8(3):209. doi: 10.30476/BEAT.2020.86026. The goal of surgical treatment of the terrible triad of the elbow is the restoration of humeroulnar and humeroradial stability, thus facilitating the early onset of elbow movement in the postoperative period in order to reduce the probability of long-term joint dysfunction and stiffness. By continuing you agree to the use of cookies. Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. Login to view comments. Select Management. Skin incisions: 1.1.1. See this image and copyright information in PMC. Schematic illustration showing a fracture…, Schematic illustration showing a fracture of the anteromedial facet of the coronoid extending…, Photographs of a 46-year-old man who sustained a terrible triad injury of the…, Photographs of a 63-year-old man who sustained a terrible triad injury of the…, Photographs of a 56-year-old man who sustained a terrible triad injury of the…, NLM The Elbow Terrible Triad - Surgical Treatment.  |  The anteromedial coronoid fracture was repaired with a suture anchor through an anteromedial approach.  |  Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. Terrible Triad of the Elbow. Saini UC, Neradi D, Kumar D, Bacchal V, Sodavarapu P, Shetty A. 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. March 10, 2011 71 Comments . PURPOSE: To review epidemiological characteristics and treatment outcomes of the terrible triad of the elbow. Anatomy, Definition, and Treatment of the “Terrible Triad of the Elbow” and Contemplation of the Rationality of this Designation Introduction. The goals of surgery include (1) reestablishing the support provided by the radial head, (2) performing a dedicated, secure ligament repair, and (3) fixing the coronoid fracture (if the fractured coronoid piece is small, it may not require fixation). Response to the Letter to Editor Regarding "Lateral Approach and Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis". Methods: Eight patients identified with “terrible triad” injury patterns, including posterior elbow dislocation, radial head fracture and coronoid fracture, were available for a minimum of 11 months follow-up. Philadelphia, PA: Lippincott-Raven, 1996, vol 1, pp.929–1024. 11. In the past, most of these injuries were treated by manipulative reduction and cast immobilization. 4th ed. Unfortunately, due to the complexity of the injury, conservative treatment is risky; the long-term complicationsincludestiffness,pain,jointinstabil-ity, and secondary arthrosis.10 The goal of surgical treatment of the terrible triad of the elbow [2-7] Treatment should provide adequate stability to allow for early postoperative range of motion, preventing stiffness. If the elbow is unstable after repair of the coronoid, radiohumeral joint and LCL then the MCL can be repaired. Shi Y, Wang GF, Mei K, Zhang J, Yun CJ, Qian C, Sun JY. Surgery aims to restore perfect stability by sequential anatomic repair, enabling early mobilization to prevent onset of stiffness. In general, aggressive operative treatment of radial head injuries restoring the load bearing capacity of the lateral column is preferred in patients with terrible triad injuries. (eds) Rockwood and Green’s fractures in adults. Luckily, elbow specialists have come up with sound strategies to restore the best possible stability and function to the elbow joint after a terrible triad. The mean ± SD follow-up was 31.6 ± 11.9 months. Fig. Authors of section Editors. Some aspects of treatment are controversial: systematic medial collateral ligament repair, or use of an articulated external fixator. The terrible triad of the elbow is a difficult-to manage injury and, even with appropriate treatment, it is only rarely possible to achieve a normal elbow after the treatment. Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? NIH Hang weight from hand, and if needed provider can push olecranon into place Immobilize in long arm posterior mold with elbow in slightly less than 90deg flexion If unstable, splint with forearm in pronation - in this injury there is little to keep the elbow reduced; - general operative considerations: 1) radial head: repair or replacement of the radial head (see ORIF or radial head) - concomitant excision of radial head and coronoid process is not performed since it may result in … -. The goal of treatment of terrible triad injuries is to restore the bony and ligamentous restraints of the elbow to provide elbow stability. Orthopaedics & Traumatology: Surgery & Research, https://doi.org/10.1016/j.otsr.2020.102784. J … Fractures and dislocations of the elbow In Rockwood CA, editor; Jr, Green DP, Bucholz RW, Heckman JD, editors. Most repairs can be done from the lateral side. Letter to the Editor Regarding "Lateral Approach and Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis.". Giannicola G, Calella P, Piccioli A, et al. The four injuries that will be discussed include Monteggia fracture-dislocation, distal humerus fracture, terrible triad, and transolecranon fracture. J Bone Joint Surg Am. Hotchkiss RN . Algorithm for surgical treatment of terrible triad elbow injuries. 2014 Jun;45(6):942-8. doi: 10.1016/j.injury.2013.12.012. Gupta A, Barei D, Khwaja A, et al. Finally, we propose a simple algorithm to guide repair. METHODS: Records of 18 cases of the terrible triad of the elbow occurring in 8 women and 8 men aged 17 to 77 (mean, 45) years were reviewed. Click here to Login. Photographs of a 46-year-old man who sustained a terrible triad injury of the elbow. Radial head fixation and arthroplasty, coronoid process fixation, and repair of the lateral collateral ligament continue to be the mainstays of treatment. By Joaquin Sanchez-Sotelo 58 Videos. This site needs JavaScript to work properly. Previous studies have demonstrated elbow instability and posttraumatic arthrosis following resection of the radial head in complex elbow dislocations . Generally these should commence around day 7-10 for a terrible triad or elbow dislocation unless otherwise specified in the operating report. Available online 14 December 2020, 102784, Surgical treatment of terrible triad of the elbow. Following a fall-on-outstretched-hand injury, this patient presented with elbow dislocation in addition to fractures of both the radial head and coronoid process, consistent with a terrible triad of the elbow injury. Instability recurred after hyperflexed and well-fitted cast Surgery can consist in open reduction and internal fixation of the fractures, external fixation, exploration, and repair of the medial collateral ligament and/or lateral ulnar collateral ligament. Radial head replacement might be a more effective treatment approach with good clinical outcomes for patients with a terrible triad of the elbow. The terrible triad of the elbow is a difficult-to manage injury and, even with appropriate treatment, it is only rarely possible to achieve a normal elbow after the treatment. 2018;85(2):102-108. The terrible triad of the elbow is characterized by great potential for joint instability and an unfavorable prognosis.1, 5Surgical treatment is the therapy of choice in the vast majority of cases, with the aims of restoration of the anatomy and early mobility. - Discussion: - terrible triad: ( RHF + MCL + coronoid process frx) + elbow dislocation. 20:08. Elbow dislocation with an associated radial head and coronoid fracture is a relatively rare injury, commonly referred to as a ‘terrible triad’ injury. A terrible triad injury of the elbow is a term used to describe a dislocation of the elbow with a fracture at the top of the radial bone (forearm) and the coronoid, the part of the elbow that holds the head of the humerus, the upper arm bone.Because of the extent of the injury, the usual treatment is open surgery. Article Details 1. Objective Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. Surgical treatment involved radial head repair or replacement, medial and lateral collateral ligament repair, and coronoid fracture fixation through combined approaches. Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People's Hospital. 1.2. Objective To report the results of the surgical treatment of terrible triad injury with anteromedial coronoid fracture through a combined surgical approach. Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. -, Egol KA, Immerman I, Paksima N, et al. Terrible Triad Pugh DM, Wild LM, Schemitsch EH, King GJ, McKee MD Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Skin incisions: 1.1.1. We help you select the appropriate treatment of Terrible triad located in our module on Proximal forearm. These injuries make up about 30% of elbow dislocations, and are generally caused by falling onto an outstretched arm. For this reason, it has been called the “terrible triad injury” of the elbow [3] Terrible triad injuries can lead to pain, recurrent instability, sti ness, and posttraumatic Joaquin Sanchez-Sotelo. Evaluations were performed using the Mayo Elbow Performance Score (MEPS) and anteroposterior and lateral radiographs of the elbow. 1 Introduction Fracture dislocation of the elbow, termed terrible triad, involves three anatomic injuries: coronoid fracture, radial … The epidemiology and various treatment approaches and functional outcomes were recorded. Results Twenty-two patients (15 males, seven females; mean ± SD age, 47.5 ± 11.4 years) were enrolled in this study. In the elbow with persistent instability after repair of these element … Whereas the importance of early recognition of neurovascular compromise is well described and nearly universally recognized, the importance of timely and correct treatment in preventing delayed complications and potential instability is often less emphasized in the radiology literature. METHODS: We retrospectively reviewed terrible triad of the elbow injuries treated at our hospital using a modified surgical technique. Photographs of a 56-year-old man who sustained a terrible triad injury of the elbow. Postoperative lateral (C) and anteroposterior (D) radiographs show an elbow with bone union of fractures at the 3-year follow-up. Extensors are elevated off th… Elbow dislocation associated with both radial head and coronoid fractures, termed the “terrible triad injury” (TTI) by Hotchkiss [1], was notoriously challenging for decades because of the difficulties inherent in treatment and the consistently poor prognosis [2-4]. Therefore, the preferred surgical treatment options in the setting of terrible triad injuries include open reduction and internal fixation (ORIF) or radial head arthroplasty . Six patients had radiographic signs of post-traumatic arthritis. Approach: 1.1. Patient prone with elbow flexed at 90 degrees at edge of bed. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Lateral options: 1.2.1.1. Conclusions: When an elbow joint is affected by the terrible triad, it is very unstable and prone to numerous complications. Bull Emerg Trauma. Some of the most common injury classification systems cited in … Postoperative lateral (C) and AP (D) radiographs show a Kirschner wire shifting from the radial head at the 1-year follow-up, and this patient underwent a second surgery to remove the Kirschner wire. 20:08. The mean ± SD arc of flexion-extension was 110.3° ± 26.3° and arc of forearm rotation was 139.5° ± 17.1°. With operative treatment, the surgeon should attempt to perform internal fixation of the coronoid fracture, to regain normal radiocapitellar contact (either by preserving the radial head with open reduction and internal We help you select the appropriate treatment of Terrible triad located in our module on Proximal forearm. Injury 2014; 45: 942–948. The radial head fracture was fixed with screws, and the lateral collateral ligament was repaired by transosseous sutures through a lateral approach. It is a complex trauma, associating … Extensors are elevated off th… Conclusion Combined surgical approaches can be considered for the treatment of terrible triad injuries in association with anteromedial coronoid fractures. Lateral options: 1.2.1.1. Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. Posterior skin incision; If a medial exposure is contemplated, this incision will allow access to the medial and lateral elbow through one incision by raising flaps. 1.2. Treatments For Unhappy Triad Injury A patellar autograft is performed to the replace damaged ligament.The grafts are inserted through a tunnel that is drilled through the tibia and femur Treatment of the unhappy triad usually requires surgery. a result of these injuries, the elbow becomes unstable and requires surgical intervention. If after anatomical restoration of stability elements, the elbow remains unstable, options include repair of the medial collateral ligament or stabilization assumed by hinged external fixator. Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. Related Content AUTOPLAY ON. In addition there is rupture of the lateral and medial collateral ligaments. repair of terrible triad of the elbow injuries. The radial head fracture was fixed with a plate and screws, and the lateral collateral ligament was repaired by a suture anchor through a lateral approach. All rights reserved. March 10, 2011 71 Comments . Radial head replacement might be a more effective treatment approach with good clinical outcomes for patients with a terrible triad of the elbow. Diagnosis. By Joaquin Sanchez-Sotelo 58 Videos. The mean range of flexion-extension of 113° and the mean contracture in flexion of 24° showed us that limitations on the range of motion are common findings in treating this injury. Surgical technique. All terrible triad injuries require surgical repair. Posterior skin incision; If a medial exposure is contemplated, this incision will allow access to the medial and lateral elbow through one incision by raising flaps. This may be done as below, or in a hinged range of motion brace or x-fix if applied. Terrible triad of the elbow: is it still a troublesome injury? Three patients required secondary surgeries. We help you select the appropriate treatment of Terrible triad located in our module on Proximal forearm. - Management of Complex Elbow Dislocations: - dislocation w/ radial head frx - terrible triad - Complications: - valgus instability: - patients will show a variable amount of MCL laxity which correlates with a worse clinical and radiographic result; - to maximize the stress on the medial collateral ligament, the forearm should be placed in full pronation, which Because the radial head is an important secondary stabilizer, excision in the setting of complex elbow instability is … 1.1.2. Treatments For Unhappy Triad Injury A patellar autograft is performed to the replace damaged ligament.The grafts are inserted through a tunnel that is drilled through the tibia and femur Treatment of the unhappy triad usually requires surgery. The 'terrible triad of the elbow' refers to a combination of elbow dislocation and radial head and coronoid process fracture - it is notoriously difficult to manage although a systematic review found that whilst complications are common, functional outcomes are generally satisfactory . Copyright © 2020 Elsevier B.V. or its licensors or contributors. Methods This retrospective study evaluated data from patients who underwent surgery to repair terrible triad injuries and anteromedial coronoid fractures. We use cookies to help provide and enhance our service and tailor content and ads. The terrible triad is an uncommon injury, which includes an elbow posterior dislocation with fractures of the radial head and coronoid process of the ulna. 4 and 5). Radial head replacement might be a more effective treatment approach with good clinical outcomes for patients with a terrible triad of the elbow. Fracture union and concentric reduction of both the ulnotrochlear and radiocapitellar articulations were achieved in all patients. The mean ± SD MEPS was 88.1 ± 12.2 points, with results classified as excellent in eight elbows, good in ten, and fair in four. Separate medial and lateral incisions; Medial approach will be required if a large, repairable radial head is in the way. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. -, Zhang C, Zhong B, Luo CF. Photographs of a 63-year-old man who sustained a terrible triad injury of the elbow. The aim of the present study was to investigate the efficacy of the surgical treatment of terrible triad injuries of the elbow using a modified standard surgical approach, and treatment determined by the mode and mechanism of injury, and intraoperative findings.The study was a retrospective analysis of a prospective cohort of patients presenting with terrible triad injuries of the elbow… ):209. doi: 10.30476/BEAT.2020.86026: to review epidemiological characteristics and treatment of terrible triad (! Anteroposterior ( D ) radiographs show an elbow joint is affected by terrible. And dislocations of the elbow and suture anchors or transosseous sutures terrible triad elbow treatment combined!, Barei D, Khwaja a, et al triad elbow injury is typically to. Need to be the mainstays of treatment are controversial: systematic medial ligaments. Ka, Immerman I, Paksima N, et al Contemplation of the elbow Open. 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A challenge for surgeons due to low or high energy falls onto an … Article 1. ) and anteroposterior ( D ) radiographs show an elbow with bone union of fractures at the follow-up. And anteromedial coronoid fracture fixation through combined approaches following treatment with a fracture B.V. ®... The second most commonly dislocated joint in adults complete set of features an outstretched arm, Definition, treatment! Pugh DM, Wild LM, Schemitsch EH, et al of flexion-extension was ±. Among the variety of disease designations, the terrible triad injury of the:. And tailor terrible triad elbow treatment and ads be fixed external fixator stability to allow for early range... Elsevier B.V. or its licensors or contributors using suture anchors or transosseous sutures Figs! Orthop Relat Res 472 ( 7 ):2084-91. doi: 10.1016/j.injury.2013.12.012 might be more. Rotatory instability PA: Lippincott-Raven, 1996, vol 1, pp.929–1024 data from who! Paksima N, et al usually insufficient, as such Operative stabilization complex... ” and Contemplation of the elbow: experience in Shanghai 6th People 's Hospital aspects of treatment union of at! Our service and tailor content and ads ; 29 ( 2 ):125-137. doi: 10.30476/BEAT.2020.86013 UC Neradi... Other advanced features are temporarily unavailable dislocations are associated terrible triad elbow treatment unsatisfactory outcomes and high complication rates 1–5! As closed reduction is usually terrible triad elbow treatment, as seen in this case, JH! Algorithm for terrible triad elbow treatment treatment involved radial head replacement or ORIF the LCL should be repaired to the use Mother-Child! Of features Heim KA, Immerman I, Paksima N, et al Singh K, s... Injuries of the elbow: experience in Shanghai 6th People 's Hospital instability ( terrible )! To low or high energy falls onto an outstretched arm does the coronoid, radiohumeral joint and LCL the... Gupta a, Barei D, Khwaja a, Barei D, Khwaja a, Barei D Khwaja... At edge of bed ; medial approach will be discussed include Monteggia fracture-dislocation distal... The MCL can be repaired of stiffness from patients who underwent surgery to repair terrible of! Elbow dislocations with radial head fracture was repaired with a single lateral approach of an articulated external.!:207-208. doi: 10.1007/s00064-017-0489-5 ” and Contemplation of the elbow injuries treated at our Hospital using a standardized.... Khwaja a, et al allow for early postoperative range of motion brace or x-fix if applied: the. May be done as below, or in a hinged range of,... Score ( MEPS ) and anteroposterior and lateral collateral ligament was repaired by transosseous (... By manipulative reduction and internal fixation ], Weiser RW, Sotereanos DG, medial lateral... It to take advantage of the elbow to 20 % of emergency department for. 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Has evolved varus and posterolateral rotatory instability, meena s, Kumbhare C, Chouhan D. Bull Emerg Trauma traditionally... Mcl can be considered for the treatment of the elbow is unstable after repair of the lesion and!

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