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. 2017 Nov-Dec;25(6):283-286.
doi: 10.1590/1413-785220172506168821.

TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT

Roberto Yukio Ikemoto  1   2 , Joel Murachovsky  1 , Rogério Serpone Bueno  1 , Luis Gustavo Prata Nascimento  1 , Adriano Bordini Carmargo  1 , Vitor Elias Corrêa  1
Affiliations

TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT

Roberto Yukio Ikemoto et al. Acta Ortop Bras. 2017 Nov-Dec.

Abstract
in English, Portuguese

Objective: To evaluate the functional and radiographic results of patients who underwent surgical treatment for terrible triad-type elbow injuries (TTE).

Methods: We retrospectively evaluated 20 patients, including one case with bilateral injuries (total of 21 elbows) that were surgically treated from January 2004 to July 2014. We evaluated the functional results of treatment by measuring the restored range of motion (ROM) of the elbow, using the DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. Complications and the development of osteoarthritis and heterotopic ossification (HO) were also evaluated.

Results: Eight elbows (38%) required additional surgical treatment; HO was observed in eight elbows (38%) and severe osteoarthritis (Broberg-Morrey type IV) was seen in only one case (4%). Nevertheless, we obtained good functional results, 14.27 on the DASH and 84 on the MEPS. The average ROM for flexion-extension was 101° (20-140°) and for pronation-supination was 112.85° (0-180°).

Conclusion: When TTE injuries are treated systematically, even despite variations in these injuries, functional ROM and scores ranging from good to excellent can be obtained. Level of Evidence IV, Case Series.

Objetivo: Avaliar os resultados funcionais e radiográficos dos pacientes que sofreram lesões do tipo tríade terrível do cotovelo (TTC) e foram tratados cirurgicamente.

Métodos: Foram avaliados retrospectivamente 20 pacientes, um caso com lesão bilateral (21 cotovelos), que foram tratados cirurgicamente no período de janeiro de 2004 a julho de 2014. Os resultados funcionais do tratamento foram avaliados pela medida da restauração do arco de movimento (ADM) do cotovelo, de acordo com os escores DASH (Disabilities of the Arm, Shoulder and Hand) e MEPS (Mayo Elbow Performance Score). Além da presença de complicações, avaliou-se osteoartrose e ossificação heterotópica (OH).

Resultados: Oito cotovelos (38%) foram submetidos a novo procedimento cirúrgico; observou-se OH em oito cotovelos (38%) e apenas um caso (4%) de artrose grave (tipo IV de Broberg-Morrey). Apesar disso, foram obtidos bons resultados funcionais, DASH de 14,27 e MEPS de 84. E o ADM médio de flexão-extensão foi de 101o (20o e 140o) e de pronação-supinação, 112,85o (0o até 180o).

Conclusão: Quando se realiza tratamento sistematizado nas lesões do tipo TTC, mesmo com suas variações, pode-se obter um ADM funcional e escore funcional entre bom e excelente. Nível de Evidência IV, Série de Casos.

Keywords: Elbow joint/physiopathology; Elbow joint/surgery; Joint dislocations; Treatment outcome.

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Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1
Figure 1. Patient occupations at time of trauma.
See this image and copyright information in PMC

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