Application of suture anchors through the approach of laterally splitting extensor digitorum communis muscle for selective repair of coronoid process fracture in terrible triad injury of the elbow

Abstract

Objective To investigate the clinical results of suture anchors through the approach of laterally splitting extensor digitorum communis muscle in the treatment of coronoid process fracture in terrible triad injury of the elbow. Methods From October 2009 to October 2014, 12 patients with terrible triad injury of the elbow were treated by suture anchors through the approach of laterally splitting extensor digitorum communis muscle to repair the anterior articular capsule of the elbow and fix the coronoid process fracture. The structures of injuries were coronoid process, radial head and lateral ligament complex which were repaired from deep to shallow. The stability of elbow joint was evaluated and the medial collateral ligament was repaired if necessary. Results All the patients were follow-up for 24 to 50 months, with an average of 29 months. The average flexion and extension arc was (116±10)°, extension limited (16±8)°, flexion (131±6)°. The average forearm rotation arc was (140±12)°, pronation (70±10)°, supination (69±8)°. According to the Mayo elbow scoring system, the elbow function evaluation was excellent in 7 cases and good in 5 cases. No fracture nonunion and failure of internal fixation were observed. All patients maintained the concentric joint reduction of the radial joint and the ulnar joint, and there was no instability of the elbow joint. Ectopic ossification around the elbow occurred in 2 cases. Radial nerve palsy occurred in 1 case which recovered completely after 2 months. Conclusion Application of suture anchors through the approach of laterally splitting extensor digitorum communis muscle for selective repair of coronoid process fracture in terrible triad injury of the elbow achieved satisfactory clinical results, but the operation indication should be mastered strictly. Key words: Elbow; Fractures,bone; Terrible triad injury