title: Radial head replacement or repair for the terrible triad of the elbow: which procedure is better?
abstract: BACKGROUND
  The terrible triad of the elbow comprises an ulnar coronoid process fracture, a radial head (RH) fracture and posterior dislocation of the elbow. It is considered severe by many clinicians because it is difficult to repair and has a poor prognosis; therefore, it deserves more attention.
  
  
  METHODS
  Thirty-nine patients with terrible triad of the elbow characterized by a Mason type-III RH fracture were randomly divided into either an RH repair group (n = 19) or an RH replacement group (n = 20). The complication rates, radiological outcomes, Mayo Elbow Performance Score and range of motion of the elbow were analysed.
  
  
  RESULTS
  Follow-up demonstrated no subluxation or recurrent dislocation of the elbow. Differences in surgery duration between the groups were significant (P < 0.001). The outcomes in terms of Mayo Elbow Performance Score (P = 0.009), flexion-extension arc (P = 0.01) and pronation-supination arc (P = 0.04) were significantly better in the RH replacement group. In addition, patients in the RH replacement group displayed significantly fewer post-surgery complications than those in the RH repair group (P = 0.04).
  
  
  CONCLUSIONS
  Treating Mason type-III RH fracture in a terrible triad of the elbow with a metal RH prosthesis resulted in better clinical outcomes and fewer post-surgery complications than treating a terrible triad of the elbow by repairing it with screws or plates. RH replacement might be a more effective approach to better managing a terrible triad of the elbow.
authors.affiliation: Department of Orthopaedic Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Mingming
authors.initials: M
authors.lastname: Yan
authors.affiliation: Department of Orthopaedic Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Jiangdong
authors.initials: J
authors.lastname: Ni
authors.affiliation: Department of Orthopaedic Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Deye
authors.initials: D
authors.lastname: Song
authors.affiliation: Department of Orthopaedic Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Muliang
authors.initials: M
authors.lastname: Ding
authors.affiliation: Department of Orthopaedic Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Tang
authors.initials: T
authors.lastname: Liu
authors.affiliation: Department of Orthopaedic Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Huang
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D004551:Elbow Joint / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D004204:Joint Dislocations / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011884:Radius / Q000601:surgery*; D011885:Radius Fractures / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D055815:Young Adult
keywords: elbow; fracture; radial head replacement; terrible triad