Comparative study of single lateral incision and combined lateral and medial incisions for treatment of terrible triad of the elbow

Abstract

Objective To investigate the clinical outcomes of terrible triad of the elbow treated with single lateral incision versus combined lateral and medial incisions. Methods This retrospective cohort research involved 57 patients with terrible triad of the elbow operated between July 2010 and June 2013. According to the surgical approaches, the patients were assigned to single lateral incision (Group A, n=32) and combined lateral and medial incisions (Group B, n=25). Group A consisted of 21 males and 11 females, with a mean age of (40.2±3.3)years. Group B consisted of 18 males and seven females, with a mean age of (39.1±2.6)years. Operation time, blood loss, postoperative complications, elbow range of motion, Mayo elbow performance score (MEPS) and Hastings and Graham heterotopic ossification classification were compared between groups. Results There were no significant differences in operation time and blood loss between Group A and B (P>0.05). Incidence of ulnar nerve injury and strength decrease were higher in Group A than Group B (P<0.05). After a mean follow-up of 25.9 months, elbow extension-flexion and forearm pronation-supination in Group A [(123.4±6.5)°, (167.5±6.0)°] were better than those in group B [(84.9±27.2)°, (136.5±8.5)°](P<0.01), and MEPS in Group A [(95.8±1.2)points] was also better than that in Group B[(84.9±3.1)points] (P<0.01). Heterotopic ossification was more serious in Group B than Group A (P<0.01). Conclusion Single lateral incision is associated with better function and lower rate of heterotopic ossification than combined lateral and medial incisions in treating terrible triad of the elbow. Key words: Elbow joint; Dislocations; Radius; Surgical approach