title: Terrible triad of the elbow: treatment protocol and outcome in a series of eighteen cases.
abstract: The terrible triad is an uncommon injury, which includes an elbow posterior dislocation with fractures of the radial head and coronoid process of the ulna. In addition there is rupture of the lateral and medial collateral ligaments. The short-term and long term results are historically poor, with a high rate of complications. The main objective of this study is to report the results of a multicentre study of patients who sustained the terrible triad injury focusing on surgical treatment in order to offer a standardized surgical protocol. We retrospectively review the results of surgical treatment of eighteen terrible triads from a multicentre study of 226 elbow dislocations. At an average follow up of 31.5 months postoperatively, all eighteen patients returned for clinical examination, functional evaluation, and radiographs. The mean MEPS score value was 78 (25-100), which correspond to three excellent results, ten good results, three fair results, and two poor results. Five early and three late complications were reported. This particular case of elbow dislocation is very unstable and leads to many complications. The surgeon should attempt to restore stability by preserving the radial head whenever possible or replacing it with prosthesis otherwise, by repairing the lateral collateral ligament and performing fixation of the coronoid fracture. If after anatomical restoration of stability elements, the elbow remains unstable, options include repair of the medial collateral ligament or stabilization assumed by hinged external fixator.
authors.affiliation: Department of Orthopaedics and Trauma Surgery, Hôpital Avicenne, AP-HP, Univ Paris XIII, 125 rue de Stalingrad, 93909 Bobigny, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Pierrart
authors.affiliation: Department of Orthopaedics and Trauma Surgery, Antoine Béclère Hospital, AP-HP, Univ Paris-Sud, 157 rue de la Porte de Trivaux, 92140 Clamart, France. Electronic address: thierry.begue@abc.aphp.fr.
authors.forename: Thierry
authors.initials: T
authors.lastname: Bégué
authors.affiliation: Department of Orthopaedics and Trauma Surgery, C.H.U. Toulouse/Purpan - Place du Dr Baylac, 31059 Toulouse, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Mansat
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D017885:Collateral Ligaments / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D004550:Elbow / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D004204:Joint Dislocations / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011885:Radius Fractures / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000503:physiopathology / Q000601:surgery*; D000092464:Elbow Injuries
keywords: Elbow dislocation; Hinged external fixator; Instability; Terrible triad