[Operative treatment of terrible triad injury of the elbow : Open reduction and internal fixation].
OBJECTIVE
Reconstruction of the most important ligamentous and osseus structures of the elbow after terrible triad injury via the radial head to the lateral collateral ligament complex (LCL) and if necessary beginning at the coronoid process. The aim is a stable concentrically guided elbow with early functional follow-up treatment. The approach depends on the intraoperatively tested stability.


METHODS
Osteoligamentous terrible triad injury pattern with or without subluxation position following reduction and temporary immobilization.


METHODS
Inoperable due to comorbidities. Concentric elbow with radial head fracture without impairment of pronation/supination, coronoid fragment <50% and stable range of motion up to 30°.


METHODS
Lateral access according to Kaplan or Kocher in order to address the anterior capsule/coronoid tip. Stabilization of the radial head with mini fragment screws and plates or radial head prosthesis. Osseous reinsertion of the LCL at its origin with transosseous sutures/bone anchors on the radial epicondyle of the humerus. In cases of persisting instability (hanging arm test) treatment with lateral movement fixation and/or the medial collateral ligaments from medial.
Immobilization in upper arm plaster cast in the first postoperative days, active assistive pain-adapted movement therapy in the cast from postoperative day 1 and after 6-8 weeks resistive therapy in the whole elbow.


RESULTS
Control of 15 terrible triad patients (mean age 45.9 years, range 20-87 years) after 9.6 months (range 2.6-31.6 months), extent of movement flexion/extension 131/14/0°, pronation/supination 78/0/67°. Arthrolysis after an average of 38 weeks in 4 patients, signs of joint arthrosis in 8, heterotopic ossification in 7 and neuropathic complaints in the region of the ulnar nerve in 1 patient. Early functional therapy with reproducible results by stabilization of osteoligamentous structures.
Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, 6000, Luzern, Schweiz. reto.babst@luks.ch.
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R
Babst
Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, 6000, Luzern, Schweiz.
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C
Schraner
Klinik für Orthopädie und Unfallchirurgie, Luzerner Kantonsspital, 6000, Luzern, Schweiz.
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FJ
Beeres
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004551:Elbow Joint / Q000601:surgery*; D019317:Evidence-Based Medicine; D000072039:Fracture Dislocation / Q000601:surgery*; D017102:Fracture Healing; D006801:Humans; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D011885:Radius Fractures / Q000517:prevention & control / Q000601:surgery*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome; D014457:Ulna / Q000293:injuries / Q000601:surgery; D014458:Ulna Fractures / Q000534:rehabilitation / Q000601:surgery*; D000092464:Elbow Injuries
Elbow dislocation fractures; Pathomechanism; Surgical and conservative therapy; Terrible triad