title: Operative Treatment of Terrible Triad of the Elbow via Posterolateral and Anteromedial Approaches.
abstract: The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow. The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. The mechanism of injury included fall from height in 9 patients and traffic accident in 3. According to O'Driscoll classification for fractures of the ulnar coronoid, there were 11 patients with type Ⅰ and 1 with type Ⅱ fractures. According to Mason classification for fractures of the radial head, there were 3 patients with type Ⅰ, 7 with type Ⅱ and 2 with type Ⅲ fractures. All patients were followed up for 12-27 months (average 15.5 months), which showed no pain or severe pain in all patients except for 2 patients with mild pain. At the last follow-up, the mean flexion was for 125°(range, 90°-140°), the mean extension loss for 20°(range, 0°-70°), the mean pronation for 66°(range, 20°-85°) and the mean supination for 60°(range, 30°-85°). The bony union time was 8-14 weeks (average 11 weeks) and the elbows were stable in flexion-extension and varus-valgus in all patients. The elbows maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation. Mild heterotopic ossification of the elbow occurred in 3 patients at 6 months after operation and mild degenerative change in 1 patient at 18 months after operation. The Broberg and Morrey elbow performance score was 82 points (range, 58-98 points). The results were excellent in 6 patients, good in 4, fair in 1 and poor in 1, with excellence rate of 83.3%. The results showed that the combined posterolateral and anteromedial approaches can facilitate the reduction and fixation of terrible triad of the elbow. Repair of radial head, coronoid, medial and lateral collateral ligaments can sufficiently restore the elbow stability, allow early postoperative motion and enhance the functional recovery.
authors.affiliation: Department of Orthopedics, Central Hospital of Yiwu City, Yiwu 322000, China.
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Chen
authors.affiliation: 8th Department, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China.
authors.forename: Guo-dong
authors.initials: GD
authors.lastname: Liu
authors.affiliation: Department of Anesthesiology, General Hospital of Chengdu Military Command, Chengdu 610083, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Ou
authors.affiliation: Traumatic Center, Research Institute of Surgery, Daping Hospital, Third Military Medical University, Chongqing 400042, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Fei
authors.affiliation: Department of Orthopedics, Central Hospital of Yiwu City, Yiwu 322000, China.
authors.forename: Gang-sheng
authors.initials: GS
authors.lastname: Zhao
authors.affiliation: Digital Medical Research Institute, Wenzhou Medical College, Wenzhou 325027, China.
authors.forename: Li-Jun
authors.initials: LJ
authors.lastname: Wu
authors.affiliation: Department of Orthopedics, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou 325027, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Pan
mesh_terms: D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D004551:Elbow Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011859:Radiography; D016896:Treatment Outcome; D055815:Young Adult; D000092464:Elbow Injuries