Complications of treating terrible triad injury of the elbow: a systematic review.
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. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications following surgical management of TTIE.


METHODS
Medline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had TTIE, and were published in English. Outcomes of interest were functional outcomes and complications.


RESULTS
Sixteen studies, involving 312 patients, were included in the systematic review. Mean follow up after surgery was typically 25 to 30 months. Mean Mayo elbow performance scores ranged from 78 to 95. Mean Broberg-Morrey scores ranged from 76 to 90. Mean DASH scores ranged from 9 to 31. The proportion of patients who required reoperation due to complications ranged from 0 to 54.5% (overall  = 70/312 [22.4%]). Most of these complications were related to hardware fixation problems, joint stiffness, joint instability, and ulnar neuropathy. The most common complications that did not require reoperation were heterotopic ossification (39/312 [12.5%] patients) and arthrosis (35/312 [11.2%] patients).


CONCLUSIONS
The results of this systematic review indicate that functional outcomes after surgery for TTIE are generally satisfactory and that complications are common. Further research is warranted to determine which surgical techniques optimize functional outcomes and reduce the risk of complications.
Department of Orthopedics, Wenzhou Medical College-Affiliated Yiwu Central Hospital, Yiwu, Zhejiang, China.
Hong-wei
HW
Chen
Department 8, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing, P.R. China.
Guo-dong
GD
Liu
Department of Orthopedics, Wenzhou Medical College-Affiliated Second Hospital, Wenzhou, Zhejiang, China; Institute of Digital Medicine, Wenzhou Medical College, Wenzhou, Zhejiang, China.
Li-jun
LJ
Wu
D000293:Adolescent; D000328:Adult; D000368:Aged; D004550:Elbow / Q000503:physiopathology* / Q000601:surgery*; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000503:physiopathology*; D007593:Joint Instability / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000150:complications; D011183:Postoperative Complications; D011885:Radius Fractures / Q000503:physiopathology*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult; D000092464:Elbow Injuries