Single pulley double-strand anchor suture fixation of the coronoid process in terrible triad of the elbow injury.

Kai-Cheng Lin,Yi-Ching Tsai,Tzu-Wei Lin,Wei-Yi Lai,Chia-Lin Wang,Hsiao-Yun Tai,Yi-Yin Lin,Yi-Ping Yang,Yih-Wen Tarng,Fu-Ting Tsai

doi:10.1097/jcma.0000000000000633

Abstract

Terrible triad of the elbow injury is difficult to manage, and the role of the coronoid process in instability is very important. We describe a simple, modified suture technique to fix a coronoid process fragment using suture anchor fixation. Eight patients (three female and five male) with coronoid process injuries with the fragment involving <50% of the total height (Regan-Morrey type I/II) in terrible triad of elbow injury were included. Patients were treated operatively via a lateral Kocher's approach, and coronoid process fractures were repaired with a single pulley double-strand suture technique. Structures were addressed in a sequential fashion-the coronoid process, radial head, lateral ulnar collateral ligament. All patients were treated with the single pulley double-strand anchor suture technique and the coronoid process fragment was found to be in good contact with the original avulsion site using the method. The final Mayo Elbow Performance Score was excellent (> 90) in six patients and good (between 85 and 89) in two patients after operation 6 months. The single pulley double-strand suture tie method using a suture anchor is a less invasive and simpler fixation method for the repair of coronoid process fractures in patients with terrible triad of the elbow injuries and results in good outcomes.

Highlights

Terrible triad of the elbow injury is difficult to manage, and the role of the coronoid process in instability is very important
Terrible triad of the elbow is difficult to manage because it is a combination of a coronoid process avulsion fracture, radial head fracture, and posterolateral dislocation of the elbow, which results in extreme elbow instability.[1,2,3,4]
Conservative treatment is recommended for Morrey type I/II coronoid process fractures, but they typically occur with simple posterior dislocation without any collateral ligament injury.[6]

Summary

Introduction

Terrible triad of the elbow injury is difficult to manage, and the role of the coronoid process in instability is very important. Terrible triad of the elbow is difficult to manage because it is a combination of a coronoid process avulsion fracture, radial head fracture, and posterolateral dislocation of the elbow, which results in extreme elbow instability.[1,2,3,4] In many cases, surgical fixation is incomplete leading to instability, limited range of motion (ROM), and elbow stiffness.[5] The avulsed coronoid process fragment is responsible for most loss of fixation because many surgeons consider it a Regan-Morrey type I/II coronoid process tip fracture.[6] Conservative treatment is recommended for Morrey type I/II coronoid process fractures, but they typically occur with simple posterior dislocation without any collateral ligament injury.[6] In most cases the anterior capsule is intact, and closed reduction is sufficient because the elbow is stable. In terrible triad of the elbow, there is anterior capsule disruption with coronoid process tip avulsion, and a lateral ulnar collateral ligament (LUCL) avulsion tear that results in posterolateral rotation instability.[7,8] The relative instability of the elbow is due to loss of the anterior buttress of the elbow if fixation of coronoid process tip is not performed. 2,7,8 coronoid process fixation is bone fixation, and serves as anterior capsule repair, and is very important for achieving elbow stability.[8,9,10]

Methods

Results

Conclusion