Efficacy evaluation of combined anterior-lateral approach for treatment of elbow triad injuries

Abstract

Objective To discuss the surgical techniques and results of internal fixation supplemented with soft tissue repair of triad injury of the elbow via the combined anterior-lateral approach. Methods A retrospective analysis was done on 15 patients with triad injury of the elbow treated from January 2011 to August 2014. There were 10 males and 5 females, aged 38.4 years (range, 20-61 years). Injury resulted from traffic accidents in nine patients, high-level falls in three and ground-level falls in three. Radial head fractures were Mason type Ⅰ in five patients, type Ⅱ in eight, and type Ⅲ in two. Fractures of the coronoid process of the ulna were Regan-Morrey typeⅠ in four patients, type Ⅱ in ten and type Ⅲ in one. Time interval between injury and operation was 8.5 d. All patients were firstly operated on through the anterior approach to have Herbert screw fixation or anterior capsule suture lasso fixation of the coronoid fracture as well as Herbert screw fixation of the radial head fracture. And then, elbow lateral incision was made to repair lateral collateral ligament complex and common extensor tendon by 2-0 Ethibon suture. Elbow flexion-extension, forearm pronation-supination and Mayo elbow performance score (MEPS) were used to evaluate the clinical elbow functions. Complications were recorded after operation. Results All patients were followed up for mean 19.6 months (range, 12-30 months). All coronoid fractures healed. Radial head fractures in 14 patients healed. Comparison of preoperative to final follow-up variables presented significant differences in elbow flexion-extension [(45.1±5.6)° ∶(129.5±9.3)°], forearm pronation-supination [(55.4±8.7)° ∶(140.5±10.3)°] and MEPS [(25.1±9.6)points ∶(91.2±5.2)points] (P<0.01). Complications included heterotopic ossification in one patient and nonunion of radial head fracture in one patient. No neurovascular injury of the elbow, elbow residual instability, dislocation, elbow stiffness and active pain occurred. Conclusion Combined anterior-lateral approach with internal fixation and soft tissue repair is a simple and safe method that effectively restore the elbow joint function. Key words: Elbow joint; Ulna fractures; Radius fractures; Fracture fixation, internal