title: Risk of Subluxation or Dislocation After Operative Treatment of Terrible Triad Injuries.
abstract: OBJECTIVE
  The management of terrible triad injuries has evolved over the last 2 decades to include routine radial head fixation or replacement, reattachment of the lateral collateral ligament, with or without coronoid fixation. Our objective was to determine the likelihood of and factors associated with subluxation or dislocation after operative treatment of terrible triad injuries among a large group of surgeons using current techniques.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Two level I trauma centers.
  
  
  METHODS
  A total of 107 patients with operatively treated terrible triad injuries from January 2000 to June 2015.
  
  
  METHODS
  Review of patient- and surgery-related factors during the first postoperative month.
  
  
  METHODS
  Radiographic subluxation of the ulnohumeral joint.
  
  
  RESULTS
  One hundred of the 107 patients (93%) treated with open fixation of terrible triad injuries had no radiographic subluxation or redislocation. Two patients (2%) had slight transient radiographic subluxation ("drop sign") that corrected with active exercises within weeks of surgery. Five patients (5%) had persistent radiographic subluxation, 3 treated with a second surgery (3%). When treated within 2 weeks of injury, recurrent subluxation or dislocation after operative fixation of terrible triad injuries was rare (1%), provided that the radial head was replaced and the lateral collateral ligament reattached.
  
  
  CONCLUSIONS
  Radiographic subluxation is very uncommon with current operative management of terrible triad injuries of the elbow within 2 weeks. Patients treated more than 2 weeks after injury might benefit from ancillary fixation to limit subluxation (ie, cross pinning, external fixation, or internal joint stabilizer).
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; †Harvard Medical School, Boston, MA; and ‡Dell Medical School, University of Texas, Austin, TX.
authors.forename: Dafang
authors.initials: D
authors.lastname: Zhang
authors.forename: Matthew
authors.initials: M
authors.lastname: Tarabochia
authors.forename: Stein
authors.initials: S
authors.lastname: Janssen
authors.forename: David
authors.initials: D
authors.lastname: Ring
authors.forename: Neal
authors.initials: N
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D015897:Comorbidity; D004551:Elbow Joint / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control / Q000601:surgery; D011885:Radius Fractures / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D014458:Ulna Fractures / Q000453:epidemiology / Q000601:surgery*; D000092464:Elbow Injuries