title: TERRIBLE TRIAD OF THE ELBOW: EVALUATION OF SURGICAL TREATMENT.
abstract: OBJECTIVE
  To evaluate the epidemiology of and surgical results from treating elbow fracture-dislocations, including only the cases in which dislocation is associated with fracture of the coronoid process and the radial head (terrible triad).
  
  
  METHODS
  Nineteen patients were evaluated: 12 males and 7 females. The medical records were analyzed to gather data about the mechanism of injury, fracture pattern, time elapsed until surgery and type of procedure applied. A clinical assessment was made to measure elbow range of motion, and the MEPS questionnaire was applied.
  
  
  RESULTS
  The most common mechanism of injury in our sample was a fall from a height (12 patients). All the patients underwent surgical treatment and the mean time elapsed between the date of the injury and the surgery was 16.1 days. The mean follow-up was 50.3 months. The mean range of flexion-extension obtained was 112° and the mean range of pronation-supination obtained was 127.9°. The mean score from the MEPS questionnaire was 86 points, and excellent and good results were obtained for 15 patients (79%). The time elapsed until surgery, final flexion-extension range greater than 100° and flexion contracture of less than 30° were shown to have a statistically significant relationship with a good final clinical result. Five patients had complications, of which three cases related to peripheral nerves, one case to pseudarthrosis and one case to recurrent instability.
  
  
  CONCLUSIONS
  Despite the severity of the injuries found in the terrible triad of the elbow, most of the patients evaluated here achieved elbow stability with good clinical results. The factors that led to better clinical results were surgery not more than 14 days after the injury, flexion-extension range greater than 100° and flexion contracture less than 30°.
authors.affiliation: Attending Physician in the Upper Limb Group, Hospital das Clínicas, Federal University of Uberlândia, MG, Brazil.
authors.forename: Leandro Cardoso
authors.initials: LC
authors.lastname: Gomide
authors.affiliation: Head of the Upper Limb Group, Hospital das Clínicas, Federal University of Uberlândia, MG, Brazil.
authors.forename: Dagoberto de Oliveira
authors.initials: Dde O
authors.lastname: Campos
authors.affiliation: Attending Physician in the Upper Limb Group, Hospital das Clínicas, Federal University of Uberlândia, MG, Brazil.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Ribeiro de Sá
authors.affiliation: Attending Physician in the Upper Limb Group, Hospital das Clínicas, Federal University of Uberlândia, MG, Brazil.
authors.forename: Marcelo Rangel
authors.initials: MR
authors.lastname: Pamfílio de Sousa
authors.affiliation: Resident in the Upper Limb Group, Hospital das Clínicas, Federal University of Uberlândia, MG, Brazil.
authors.forename: Thiago Correa
authors.initials: TC
authors.lastname: do Carmo
authors.affiliation: Third-year Resident in Orthopedics, Hospital das Clínicas, Federal University of Uberlândia, MG, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Brandão Andrada
keywords: Dislocations; Elbow Joint; Radius Fractures