Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Jun 11;53(4):460-466.
doi: 10.1016/j.rboe.2018.05.012. eCollection 2018 Jul-Aug.

Terrible triad of the elbow: evaluation of surgical treatment

José Antonio Galbiatti  1 , Fabrício Luz Cardoso  1 , James Augusto Soares Ferro  2 , Rafael Cassiolato Garcia Godoy  2 , Sérgio de Oliveira Bruno Belluci  2 , Evandro Pereira Palacio  3
Affiliations

Terrible triad of the elbow: evaluation of surgical treatment

José Antonio Galbiatti et al. Rev Bras Ortop. .

Abstract
in English, Portuguese

Objective: This study aims at analyzing retrospectively the clinical-functional and radiographic results of surgical treatment of the terrible elbow triad, with at least 12 months of postoperative follow-up evaluating elbow function.

Methods: A group of patients for retrospective analysis from 2004 to 2015 was defined, in which 12 patients were studied. They underwent surgery due to fracture of the radial head, coronoid fracture, and elbow dislocation; they were evaluated by the Disabilities of the Arm, Shoulder and Hand (DASH) score, the degree of patient satisfaction, the degree of trauma energy, radiographic images, range of motion, and complications.

Results: There was a higher incidence of Regan and Morrey type II coronoid process fractures; in relation to the injuries, nine patients had deinsertion of the brachialis. Half of the patients suffered a fall from their own height as the mechanism of trauma. The extent of elbow flexion and extension averaged 126.6 and 24.1 degrees, respectively; the averages for pronation and supination were 64.1 and 62.0 degrees, respectively. All patients presented muscle strength of grade IV or V. The mean DASH score was 14.3, the mean pain score was 2.5, and a majority of the patients were satisfied with the treatment.

Conclusion: Despite the total loss of range of motion of the elbow, especially in extension, the treatment was satisfactory for most patients.

Objetivo: Este estudo tem o objetivo de analisar, retrospectivamente, os resultados clínico- funcionais e radiográficos do tratamento cirúrgico da tríade terrível do cotovelo, com no mínimo doze meses de acompanhamento pós-operatório, avaliando a função do cotovelo.

Métodos: Definimos um grupo de pacientes para avaliação retrospectiva no período de 2004 a 2015, no qual foram estudados 12 pacientes, submetidos a procedimento cirúrgico devido a fratura da cabeça do rádio, fratura do processo coronoide e luxação do cotovelo; sendo avaliados pelo escore Disabilities of the Arm, Shoulder and Hand (DASH), grau de satisfação do paciente, grau de energia do trauma, radiografias, arco de movimento e complicações.

Resultados: Observou-se maior incidência de fraturas do processo coronoide do tipo II de Regan e Morrey; em relação às lesões, nove pacientes apresentaram desinserção do músculo braquial. Metade dos pacientes apresentou queda da própria altura como mecanismo de trauma. Os graus de flexão e extensão do cotovelo tiveram respectivamente as médias: 126,6 e 24,1 graus; e as médias em graus de pronação e supinação foram respectivamente: 64,1 e 62,0 graus. Todos os pacientes apresentaram grau de força muscular IV ou V. Obtivemos escore DASH médio de 14,3, a escala de dor teve média de 2,5, e a maioria dos pacientes se disse satisfeita com o tratamento.

Conclusão: Apesar da perda de amplitude total de movimento do cotovelo, principalmente em extensão, o tratamento mostrou-se satisfatório para a maioria dos pacientes.

Keywords: Dislocations; Elbow joint; Orthopedics; Radial fractures.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Radiographs showing the terrible triad of the elbow.
Fig. 2
Fig. 2
Osteosynthesis of the radius and proximal ulna.
Fig. 3
Fig. 3
Medial incision of the elbow, isolation of the ulnar nerve, and repair of the medial collateral ligament.
Fig. 4
Fig. 4
Prevalence of cases in relation to gender.
Fig. 5
Fig. 5
Elbow flexion.
Fig. 6
Fig. 6
Elbow extension.
Fig. 7
Fig. 7
Forearm pronation.
Fig. 8
Fig. 8
Forearm supination.
See this image and copyright information in PMC

References

    1. Hebert S., Barros Filho T.E.P., Xavier R., Pardini Junior A.G. 4a ed. Artmed; Porto Alegre: 2009. organizadores. Ortopedia e traumatologia: princípios e pratica.
    1. Mathew P.K., Athwal G.S., King G.J. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg. 2009;17(3):137–151. - PubMed
    1. Morrey B.F., Chao E.Y., Hui F.C. Biomechanical study of the elbow following excision of the radial head. J Bone Joint Surg Am. 1979;61(1):63–68. - PubMed
    1. Barbieri C.H., Mazzer N., Madureira W. Fraturas da cabeça do radio: revisão de 52 casos. Rev Bras Ortop. 1998;33(12):973–981.
    1. Johnston G.W. A follow-up of one hundred cases of fracture of the head of the radius with a review of the literature. Ulster Med J. 1962;31:51–56. - PMC - PubMed

LinkOut - more resources