Fracture patterns, outcomes, and complications of terrible triad injury in elderly patients

Abstract

Hypothesis: This study hypothesized that patients older than 65 years with terrible triad elbow injuries (TTEI) exhibit complex fracture patterns, a high prevalence of associated injuries, and increased rates of complications and reinterventions.

Methods: A retrospective study of 29 patients, mean follow-up of 48.7 ± 4.6 months (range 65-78). Fractures were classified according to the Mason and Regan-Morrey classifications. All patients were evaluated by the Mayo Elbow Performance Scale, Quick-Disabilities of the Arm, Shoulder, and Hand, Quality of life Visual Analog Scale, EQ5D scores, and range of motion measurement.

Results: The mean age was 72.3 years and 79% were women. Mason Type III (72%) and Reagan-Morrey type II (69%) were the most frequent fracture type. All patients were managed with a lateral approach consisting of repair or replacement of the radial head and repair of the lateral ulnar collateral ligament; of these patients, 19 underwent re-attachment of the coronoid process or anterior capsule. Mean functional scores were Mayo Elbow Performance Scale 90.3 ± 7.5, Quick-Disabilities of the Arm, Shoulder, and Hand 18.4 ± 4.6, EQ5D .89 ± 0.33, Quality of life Visual Analog Scale 86.2 ± 21, and Visual Analog Scale 2.2 ± 1.5. Mean postoperative flexo-extension arc of elbow motion was 105° (range, 65°-145°). Two patients (7%) required revision surgery. We did not observe any joint instability in the elbow after surgery.

Conclusions: Patients over 65 years old with a terrible triad elbow injury are at substantial risk of complex fracture patterns, particularly Mason type III radial head fractures and Regan-Morrey type II coronoid fractures. Complications such as joint stiffness and heterotopic ossification are infrequent, while associated capitellum fractures are not rare and should be considered in the assessment as they can impact elbow stability. Despite these challenges, surgical management generally achieves favorable functional outcomes with low complication and reoperation rates.

Keywords: Terrible triad; complex dislocation; complications; coronoid pocess; fracture pattern; radial fracture.