Abstract
Objective A multicenter study to evaluate risk factors for the development of moderate or severe posttraumatic osteoarthritis (PTOA) and to find potential preventions. Methods We conducted a retrospective multicenter study including the terrible triad injury (TTI) patients with surgical treatment from January 2007 to November 2014. Demographics, injury information, and treatment history were obtained retrospectively. According to the Broberg and Morrey criterion, 198 included patients were sorted into two groups: the mild or no PTOA and moderate or severe PTOA. Uni- and multivariate logistic regression analyses were used to identify risk factors for moderate or severe PTOA. Results Moderate or severe PTOA was present in 64 patients (32.3%). Significant risk factors were Mason III radial head fracture (OR 4.049, 95% CI 1.877-8.736, p < 0.001), medial collateral ligament injury (OR 5.120, 95% CI 1.261-20.790, p = 0.022), and heavy use of elbow (OR 2.333, 95% CI 1.060-5.136, p = 0.035). Besides, patients suffered subluxation (p = 0.007) and those with more risk factors had a higher risk to develop moderate or severe PTOA. Conclusions Moderate or severe PTOA was common after the TTI. Patients need to be counseled about avoiding heavy use of the elbow, especially for those with Mason III radial head fractures. Surgeons should be aware of the recurrent instability of the elbow.
Highlights
Elbow dislocation associated with both radial head and coronoid fractures earned its eponym “terrible triad injury” (TTI) for decades because of the poor prognosis [1]
Occupation with heavy use of upper extremities, Mason III radial head fracture, and Medial collateral ligament (MCL) injury were independently associated with the development of moderate or severe posttraumatic osteoarthritis (PTOA) and constituted the final model (Table 3)
Our results showed that the incidence of moderate or severe PTOA was lower in patients without heavy use of the elbow than those with (Figure 1)
Summary
Elbow dislocation associated with both radial head and coronoid fractures earned its eponym “terrible triad injury” (TTI) for decades because of the poor prognosis [1]. With the improvement of knowledge on elbow biomechanics and pathoanatomy, the current standard strategy appeared to have yielded more favorable outcomes [2, 3]. Complications like joint stiffness, posttraumatic osteoarthritis (PTOA), heterotopic ossification, and ulnar nerve symptoms continue to affect the prognosis of the TTI [4, 5]. PTOA is difficult to manage, especially in the highdemand or active population. It presents a challenge for both patients and orthopedic surgeons. The correlation between radiographic evidence of PTOA and symptoms is limited, especially in mild ones [9, 10].
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