Surgical treatment of "terrible triad of the elbow": technique and outcome.
OBJECTIVE
To describe the authors' surgical technique and to evaluate the final functional outcome of surgical treatment of the "terrible triad of the elbow".


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. Evaluation of functional outcome was based on Mayo elbow performance, Broberg-Morrey scores, and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Complications were also recorded.


RESULTS
Five elbows redislocated while in a splint after manipulative reduction. Three had residual subluxation after operative treatment. The final mean extent of forearm movement was as follows: 21° of extension deficit (range, 5° to 45°), 126° of flexion (range, 110° to 140°), 75° of supination (range, 45° to 90°), and 71° of pronation (range, 30° to 90°). The mean Mayo, Broberg-Morrey, and DASH scores were 78.0 ± 13.4, 76.0 ± 14.0, and 28.0 ± 24.7, respectively.


CONCLUSIONS
When an elbow joint is affected by the terrible triad, it is very unstable and prone to numerous complications. 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 fixation (ORIF) or by replacing it with a prosthesis), and to repair the lateral collateral ligament (LCL). Thus early functional recovery and a successful final functional outcome can be achieved.
Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
Yu-xing
YX
Wang
Li-xin
LX
Huang
San-hui
SH
Ma
D000328:Adult; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult; D000092464:Elbow Injuries