[Hinged external fixator with mini-plate to treat terrible triad of elbow]

Yong Yang, Fuchuan Wang
Chinese Journal of Reparative and Reconstructive Surgery 2013, 27 (2): 151-4

OBJECTIVE: To investigate the effectiveness of hinged external fixator with mini-plate to treat terrible triad of the elbow.

METHODS: Between August 2008 and June 2011, 11 patients with terrible triad of the elbow were treated with hinged external fixator combined with mini-plate. There were 9 males and 2 females, aged 22-56 years (mean, 34 years). The injuries were caused by falling from height in 8 cases and traffic accident in 3 cases. All patients were closed injury. The time from injury to operation varied from 8 hours to 7 days (mean, 3.7 days). According to Mason classification standard, all radial head fractures were type IV and complicated by posterior dislocation of the elbow; according to Regan-Morrey classification standard, ulna coronary process fractures were type I in 3 cases, type II in 3 cases, and type III in 5 cases.

RESULTS: All the patients achieved primary healing of incision after operation and no nerve injury occurred. The patients were followed up 12-20 months (mean, 15 months). Two cases had screw channel infection after 12 weeks of operation, and 1 case had mild heterotopic ossification of the elbow after 4 months of operation. X-ray films showed that all fractures healed from 8 to 20 weeks (mean, 16 weeks). No recurrent dislocation or instability of the elbow occurred. At 12 months after operation, the elbow range of motion (ROM) were 120-145 degrees (mean, 135 degrees) in flexion, 0-25 degrees (mean, 10 degrees) in extension, 50-90 degrees (mean, 70 degrees) in pronation, and 50-80 degrees (mean, 60 degrees) in supination. According to Mayo elbow function evaluation standard, the results were excellent in 5 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 81.8%.

CONCLUSION: Hinged external fixator with mini-plate can enhance postoperative stability of the elbow. This therapy is beneficial to early functional exercise and obviously decrease the disability rate caused by complex damage on the elbow.

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