Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow

Abstract

Dislocation of the elbow with associated fractures of the radial head and the coronoid process of the ulna have been referred to as the terrible triad of the elbow because of the difficulties in treating this injury and the poor outcomes. There were 23 patients (24 elbows) available for evaluation with this injury during a 7-year period at Auckland City Hospital. There were 11 women and 12 men with an average age of 43.5 years. The mean duration of follow-up was 41 months. The mean range of flexion was 135° (range, 110°-145°), extension was 8° (range, 0°-40°), supination was 75° (range, 15°-85°), and pronation was 80° (range, 20°-90°). No patients reported ongoing symptoms of instability. We compared the radial head repair group (13 patients) and the radial head replacement group (11 patients), which showed no significant difference between the variables of age, length of follow-up, American Shoulder and Elbow Surgeons score, satisfaction score, range of motion (flexion, extension, supination, pronation), and the associated arcs of motion. Only one significant difference was noted: the radial head replacement group scored higher values on the Disabilities of Arm, Shoulder, and Hand assessment. Elbow fracture-dislocations are difficult injuries to treat. Our study shows that with operative repair or replacement of the radial head to restore stability through radiocapitellar contact, coronoid, and lateral ligament repair, good range of movement and stability can be achieved at short-term follow-up.