Abstract
The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow. The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. The mechanism of injury included fall from height in 9 patients and traffic accident in 3. According to O’Driscoll classification for fractures of the ulnar coronoid, there were 11 patients with type Ⅰ and 1 with type Ⅱ fractures. According to Mason classification for fractures of the radial head, there were 3 patients with type Ⅰ, 7 with type Ⅱ and 2 with type Ⅲ fractures. All patients were followed up for 12-27 months (average 15.5 months), which showed no pain or severe pain in all patients except for 2 patients with mild pain. At the last follow-up, the mean flexion was for 125°(range, 90°-140°), the mean extension loss for 20°(range, 0°-70°), the mean pronation for 66°(range, 20°-85°) and the mean supination for 60°(range, 30°-85°). The bony union time was 8-14 weeks (average 11 weeks) and the elbows were stable in flexion-extension and varus-valgus in all patients. The elbows maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation. Mild heterotopic ossification of the elbow occurred in 3 patients at 6 months after operation and mild degenerative change in 1 patient at 18 months after operation. The Broberg and Morrey elbow performance score was 82 points (range, 58-98 points). The results were excellent in 6 patients, good in 4, fair in 1 and poor in 1, with excellence rate of 83.3%. The results showed that the combined posterolateral and anteromedial approaches can facilitate the reduction and fixation of terrible triad of the elbow. Repair of radial head, coronoid, medial and lateral collateral ligaments can sufficiently restore the elbow stability, allow early postoperative motion and enhance the functional recovery.
Highlights
Dislocation of the elbow combined with fractures of the radial head and the ulnar coronoid process is known as the terrible triad injury of the elbow
Rodriguez-Martin et al [22] reported the results of 137 elbow triad injuries from five studies and an average of 31 months of follow-up showed that posterolateral and anteromedial approaches were effective in majority of patients, with Mayo elbow performance score of 85.6 points and Broberg-Morrey score of 85 points
One advantage is that it allows access to both the medial and lateral aspects of the elbow, and precludes the need for a second medial skin incision, when the posterior skin incision has a lower risk of injury to the cutaneous nerves compared with the medial and lateral skin incisions
Summary
Dislocation of the elbow combined with fractures of the radial head and the ulnar coronoid process is known as the terrible triad injury of the elbow. Rodriguez-Martin et al [22] reported the results of 137 elbow triad injuries from five studies and an average of 31 months of follow-up showed that posterolateral and anteromedial approaches were effective in majority of patients, with Mayo elbow performance score of 85.6 points and Broberg-Morrey score of 85 points. The operation methods and clinical results of posterolateral and anteromedial approaches for terrible triad injury of the elbow were analyzed in 12 patients admitted from January 2010 to June 2012 to discuss elbow stability, early postoperative motion and functional recovery of the elbow
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