title: Terrible triad of the elbow: influence of radial head treatment.
abstract: OBJECTIVE
  to test the null hypothesis that patients with the terrible triad of the elbow (dislocation together with fractures of the radial head and coronoid process) who are treated with open reduction and internal fixation of the radial head have final results that are comparable with those of patients treated with arthroplasty or partial resection of the radial head.
  
  
  METHODS
  twenty-six patients with the terrible triad of the elbow who were operated by a single surgeon were evaluated on average 23 months after the surgery (range: 16-36 months). There were 17 men and nine women of mean age 41 ± 13.4 years. The fractures of the radial head were treated by means of osteosynthesis (12 patients), arthroplasty (nine) or resection of a small fragment or no treatment (five). Fixation of the coronoid process/anterior capsule was performed in 21 patients. The lateral ligament complex (LLC) was repaired in all the patients, while the medial ligament complex (MLC) was repaired in three patients whose elbows remained unstable after treatment for the radial head and LLC, but without fixation of the coronoid process.
  
  
  RESULTS
  the mean final range of flexion and extension was 112°. The mean pronation was 70° and supination, 6°. The mean DASH score (Disabilities of the Arm, Shoulder & Hand) was 12 and mean MEPI (Mayo Elbow Performance Index) was 87. According to the MEPI scores, 21 patients (80%) had good and excellent results. There was no statistically significant difference in the results between the patients who underwent fixation of the radial head and those who underwent arthroplasty or resection of a small fragment.
  
  
  CONCLUSIONS
  there was no difference between the patients treated with arthroplasty of the radial head and those treated with other techniques.
authors.affiliation: Serviço de Ombro e Cotovelo, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
authors.forename: Lucas Braga Jaques
authors.initials: LB
authors.lastname: Gonçalves
authors.affiliation: Serviço de Ombro e Cotovelo, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
authors.forename: Jorge de Almeida E Silva
authors.initials: Jde A
authors.lastname: Neto
authors.affiliation: Serviço de Ombro e Cotovelo, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
authors.forename: Mario Roberto Chaves
authors.initials: MR
authors.lastname: Correa Filho
authors.affiliation: Serviço de Ombro e Cotovelo, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
authors.forename: Ronaldo Percope
authors.initials: RP
authors.lastname: de Andrade
authors.affiliation: Serviço de Ortopedia, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
authors.forename: Marco Antônio Percope
authors.initials: MA
authors.lastname: de Andrade
authors.affiliation: Serviço de Ortopedia e Medicina do Esporte, Hospital Unimed, Belo Horizonte, MG, Brazil.
authors.forename: Anderson Humberto
authors.initials: AH
authors.lastname: Gomes
authors.affiliation: Serviço de Ortopedia e Medicina do Esporte, Hospital Unimed, Belo Horizonte, MG, Brazil.
authors.forename: José Carlos Souza
authors.initials: JC
authors.lastname: Vilela
keywords: Dislocations; Elbow joint; Radial fractures