Evaluation of functional outcome after nonsurgical management of terrible triad injuries of the elbow

Abstract

Terrible triad (TT) is one of the severe injuries of the elbow that generally requires surgery. Nonsurgical treatment has recently been applied in selected cases of TT injury. Evaluation of the results of this treatment was the main aim of this study. In a prospective cohort study, 10 patients with a mean follow-up of 30.6 months were evaluated. The inclusion criteria included a congruent joint after closed reduction, no indication for surgery of the coronoid and radial head fractures, no block in supination and pronation up to 60°, no intra-articular fragments, and a free and stable joint with ulnohumeral extension up to a minimum of 45°. Mayo Elbow Performance Index and Disabilities of the Arm, Shoulder, and Hand score were used for assessment of the functional outcome. A standard physical examination to record elbow range of motion was also performed. For the affected and the contralateral elbows, respectively, the mean extension of the elbow was 11° ± 7° and 0.0° ± 2°; the mean flexion was 131° ± 9° and 140° ± 10°; the mean supination was 58° ± 17° and 85 ± 7°; and the mean pronation was 53° ± 23° and 85° ± 7°. The mean Disabilities of the Arm, Shoulder, and Hand score was 4.76 ± 5.17. The mean Mayo Elbow Performance Index was 95 ± 8.16. Nonsurgical management of the TT injury can result in acceptable functional outcomes when a patient meets the criteria set for nonsurgical treatment.