Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People's Hospital

Abstract

Background: Terrible triad of the elbow can be a challenging injury to treat, with a history of well-known complications. The purpose of this study is to report the outcomes of a modification of the standard surgical protocol for the repair of terrible triad of the elbow injuries.

Methods: We retrospectively reviewed terrible triad of the elbow injuries treated at our hospital using a modified surgical technique. Our surgical procedure includes fixation or replacement of the radial head and repair of the ruptured lateral collateral ligament (LCL) through a lateral approach. Simultaneous fixation of the coronoid process and repair of the common flexor muscle and medial collateral ligament (MCL) injury were performed through an anteromedial incision. Mayo Elbow Performance Score (MEPS) was determined for each patient at the final clinic visit. The Broberg and Morrey classification was used for evaluating traumatic arthritis.

Results: There were 21 patients (21 elbows) included in the analysis, and the mean follow-up period was 32 months (range, 24-48 months). At the last follow-up the mean flexion-extension arc of the elbow was 126° and the mean forearm rotation was 139°. The mean MEPS was 95 points (range, 85-100 points), with 19 excellent results and two good results. Concentric stability was restored in all cases. Two patients had heterotopic ossification, one patient had radial head nonunion, one patient had a superficial infection, and one patient had ulnar nerve neuropathy.

Conclusion: Our surgical strategy for terrible triad of the elbow has the advantage of providing both bony and soft-tissue stability simultaneously, thereby allowing active early motion as well as functional recovery of the elbow.

Keywords: Coronoid process; Elbow; Elbow approaches; Fracture and dislocation; Terrible-triad injury; Trauma; Treatment.