[Operative treatment of terrible triad of the elbow joint]

Xinjian Kuang, Hang Cai, Feng Bao, Hongbin Huang, Jianghao Gong, Yongjian Lou, Xuhong Chen
Chinese Journal of Reparative and Reconstructive Surgery 2011, 25 (8): 964-7

OBJECTIVE: To explore the operation procedure and effectiveness of terrible triad of the joint.

METHODS: Between October 2006 and June 2010, 11 cases of closed terrible triad of the elbow joint were treated operation. There were 8 males and 3 females with an average age of 32 years (range, 21-53 years). The mechanism of was falling from height in 4 cases and traffic accident in 7 cases. The time from injury to admission was 30 minutes to According to Regan-Morrey classification for fractures of the ulnar coronoid, there were 5 cases of type I, 5 cases of type case of type III; and according to Mason classification for fractures of the radial head, there were 4 cases of type I, 5 cases II, and 2 cases of type III. The elbow joint range of motion (ROM) was (63 +/- 9) degrees at flexion and extension, and the forearm was (71 +/- 8) degrees at pronation and supination. All cases underwent reduction and fixation by lateral approach combined with approach according to McKeeps operation process. After operation, the affected limb was immobilized with plaster at joint flexion of 90 degrees and in forearm neutral position, then passive physical exercises were carried out, and finally active exercises were done after removing plaster at 4 weeks.

RESULTS: All incisions healed by first intention. Eleven cases followed up 7-27 months (14.5 months on average). The X-ray films showed good reduction, the clinical healing time was weeks with an average of 11 weeks. Mild ectopic ossification of the elbow joint occurred in 3 cases at 6 months after operation, mild degenerative change in 1 case at 18 months after operation. At last follow-up, the elbow joint ROM was (103 +/- flexion and extension, and the forearm ROM was (122 +/- 13) degrees at pronation and supination, showing no significant difference when compared with the values of normal elbow joint (P > 0.05) and significant difference when compared with the preoperative values of affected elbow joint (P < 0.05). According to Mayo elbow performance score, the results were excellent in 5 cases, in 5 cases, and fair in 1 case with an excellent and good rate of 90.9%.

CONCLUSION: The surgical treatment of terrible the elbow joint can restore sufficiently elbow stability, allow early motion postoperatively, and enhance the functional outcome.

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