[Diagnosis and treatment of terrible triad of elbow]

Jia-Wu Qi
Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology 2010, 23 (9): 654-6

OBJECTIVE: To study diagnosis and treatment methods of terrible triad of elbow.

METHODS: From June 2001 to June 2009, 7 patients with terrible triad of elbow were reviewed. Among the patients, 6 patients were male and 1 patient was female, ranging in age from 20 to 68 years, averaged 36.5 years. All the fractures were fresh. All the patients were treated through a single lateral approach. The general approach was used to repair the damaged structures sequentially from deep to superficial, from coronoid to anterior capsule, to radial head, lateral ligament complex, and common extensor origin. The coronoid fractures and the radial head fractures were fixed with different methods according to fragments. The curative effiency were evaluated by Mayo elbow performance score (MEPS).

RESULTS: All the patients were followed up, and the duration ranged from 5 to 36 months, with a mean of 16.3 months. All the fractures were healed, and the healing time ranged from 3 to 6 months after operation (averaged 4.5 months). Four patients had heterotopic ossificatio. According to evaluation criteria, 2 patients got an excellent result, 4 fair and 1 bad. The average range of motion in elbow flexion-extension were 106.5 degrees (from -20 to 130 degrees), and the range of motion in forearm pronation-supination were 121 degrees (from 70 to 140 degrees). The patient with bad results were treated with radial head excised, and Kirschner fixation from posterior to anterior after reduction, which was found separate dislocation of the coronoid fracture on the X-ray after operation, and subluxation and instability of the elbow joint.

CONCLUSION: The patients with terrible triad of elbow should be treated with operation actively. Follows are key to get an excellent result: treatment of bone and soft tissues at the same time, early rehabilitation after operation.

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