Results of terrible triads in the elbow: the advantage of primary restoration of medial structure.
BACKGROUND
The purpose of this study was to report the clinical and radiological outcomes and surgical strategy for terrible triad injury of the elbow. We hypothesized that the outcomes of this type of injury would be satisfactory if the medial structure was routinely restored at the same time as the repair of the lateral structure.


METHODS
We retrospectively reviewed the results of this treatment performed in 13 elbows with terrible triads. Our surgical protocol included fixation or replacement of the radial head and repair of the ruptured lateral ulnar collateral ligament through the lateral traumatic window. In all cases, simultaneous fixation of the coronoid and repair of the common flexor muscle were performed through the medial traumatic window. In eight patients with medial collateral ligament injury, the ligament was always repaired. The follow-up period ranged from 18 to 41 months (mean, 25 months).


RESULTS
The flexion-extension arc of the elbow averaged 128° and forearm rotation averaged 134.6°. The mean Mayo elbow performance score was 95 points (range, 85 to 100), which corresponded to ten excellent results, and three good results. Concentric stability was restored to all cases. As postoperative complications, one patient had ulnar nerve neuropathy.


CONCLUSIONS
The present operative procedures restoring all damaged lateral and medial structures through the lateral and the medial windows provided satisfactory clinical and radiological outcomes and are recommended for patients with terrible triad injury.
Department of Orthopaedic Surgery, Korea University College of Medicine, Seoul 136-705, Korea.
Woong-Kyo
WK
Jeong
Jong-Keon
JK
Oh
Jin-Ho
JH
Hwang
Seok-Min
SM
Hwang
Won-Seok
WS
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D017885:Collateral Ligaments / Q000293:injuries* / Q000601:surgery; D003286:Contracture / Q000209:etiology; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D011859:Radiography; D011885:Radius Fractures / Q000150:complications / Q000601:surgery*; D012421:Rupture; D014458:Ulna Fractures / Q000150:complications / Q000601:surgery*; D055815:Young Adult; D000092464:Elbow Injuries