title: The effect of medial side repair in terrible triad injury of the elbow.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effect of surgical repair of the medial collateral ligament and ulnar nerve release in cases of terrible triad injuries of the elbow.
  
  
  METHODS
  This study included 16 patients (average age: 34 years) who underwent surgery following a diagnosis of terrible triad injury of the elbow between 1996 and 2007. Average follow up was 34.5 months. In all cases, the radial head was first fixed or replaced and the anterior capsule/coronoid complex and lateral collateral ligament were repaired. The medial side of the elbow was addressed (medial collateral ligament repair and ulnar nerve release) in 8 cases and not addressed in the remaining 8 cases. Range of motion, pain, stability, ulnar nerve symptoms, functional Mayo Elbow Performance Index, and Disabilities of the Arm, Shoulder and Hand scores were documented. Serial X-rays were used to confirm ulnohumeral arthritis and development of ectopic calcification. Ultrasonography or MRI was used to detect ulnar nerve entrapment.
  
  
  RESULTS
  Range of motion was slightly more limited in cases where the medial side was not addressed. Ulnohumeral range of motion and flexion degrees were higher in the cases where the medial side was addressed (p<0.05). Serial X-rays demonstrated impending ectopic calcification located at the proximal insertion of medial collateral ligament in patients who did not undergo medial side repair. MRI or ultrasonography confirmed these findings, revealing swollen displaced nerves resembling findings similar to cubital tunnel syndrome.
  
  
  CONCLUSIONS
  Ulnar neuropathy is a common complication after medial collateral ligament injury and prophylactic release will facilitate overall results and postoperative patient satisfaction.
authors.affiliation: Hand Microsurgery Orthopaedics and Traumatology (EMOT) Hospital, İzmir, Turkey.
authors.forename: Tulgar
authors.initials: T
authors.lastname: Toros
authors.forename: Kemal
authors.initials: K
authors.lastname: Ozaksar
authors.forename: Tahir Sadık
authors.initials: TS
authors.lastname: Sügün
authors.forename: Murat
authors.initials: M
authors.lastname: Kayalar
authors.forename: Emin
authors.initials: E
authors.lastname: Bal
authors.forename: Sait
authors.initials: S
authors.lastname: Ada
mesh_terms: D000328:Adult; D001168:Arthritis / Q000000981:diagnostic imaging / Q000209:etiology; D017885:Collateral Ligaments / Q000601:surgery; D004185:Disability Evaluation; D004550:Elbow / Q000000981:diagnostic imaging; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation; D006801:Humans; D017746:Joint Capsule / Q000601:surgery; D008297:Male; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000517:prevention & control*; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D017769:Ulnar Nerve Compression Syndromes / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014463:Ultrasonography; D000092464:Elbow Injuries