For this reason, it has been called the “terrible triad injury” of the elbow [3] Terrible triad injuries can lead to pain, recurrent instability, sti ness, and posttraumatic All rights reserved. Photographs of a 56-year-old man who sustained a terrible triad injury of the elbow. We help you select the appropriate treatment of Terrible triad located in our module on Proximal forearm. Diagnosis. Liu G, Hu J, Ma W, Li M, Xu R, Pan Z. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach. Postoperative lateral (C) and AP (D) radiographs show a Kirschner wire shifting from the radial head at the 1-year follow-up, and this patient underwent a second surgery to remove the Kirschner wire. - in this injury there is little to keep the elbow reduced; - general operative considerations: 1) radial head: repair or replacement of the radial head (see ORIF or radial head) - concomitant excision of radial head and coronoid process is not performed since it may result in … dislocation is a common injury, its treatment has been traditionally associated with unsatisfactory outcomes and high complication rates [1–5]. The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. Orthopaedics & Traumatology: Surgery & Research, https://doi.org/10.1016/j.otsr.2020.102784. Click here to Login. The mean ± SD follow-up was 31.6 ± 11.9 months. Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. Select Management. Radial head fixation and arthroplasty, coronoid process fixation, and repair of the lateral collateral ligament continue to be the mainstays of treatment. The goals of surgery include (1) reestablishing the support provided by the radial head, (2) performing a dedicated, secure ligament repair, and (3) fixing the coronoid fracture (if the fractured coronoid piece is small, it may not require fixation). Generally these should commence around day 7-10 for a terrible triad or elbow dislocation unless otherwise specified in the operating report. Postoperative lateral (C) and anteroposterior (D) radiographs show an elbow with bone union of fractures at the 3-year follow-up. Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. Surgical treatment involved radial head repair or replacement, medial and lateral collateral ligament repair, and coronoid fracture fixation through combined approaches. COVID-19 is an emerging, rapidly evolving situation. Login to view comments. J Bone Joint Surg Am. Objective Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. NIH Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. The terrible triad of the elbow is characterized by great potential for joint instability and an unfavorable prognosis.1, 5Surgical treatment is the therapy of choice in the vast majority of cases, with the aims of restoration of the anatomy and early mobility. Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People's Hospital. This site needs JavaScript to work properly. 11 Login. 2018;85(2):102-108. 2017 Apr;29(2):125-137. doi: 10.1007/s00064-017-0489-5. Anatomy, Definition, and Treatment of the “Terrible Triad of the Elbow” and Contemplation of the Rationality of this Designation Introduction. Lateral options: 1.2.1.1. Related Content AUTOPLAY ON. Epub 2014 Jan 10. The mean range of flexion-extension of 113° and the mean contracture in flexion of 24° showed us that limitations on the range of motion are common findings in treating this injury.  |  -. Unfortunately, due to the complexity of the injury, conservative treatment is risky; the long-term complicationsincludestiffness,pain,jointinstabil-ity, and secondary arthrosis.10 The goal of surgical treatment of the terrible triad of the elbow The anteromedial coronoid fracture was fixed with K-wires and suture anchors through an anteromedial approach. It is a complex trauma, associating … An ACL surgery is common and the meniscus can be treated during the surgery as well. J Bone Joint Surg Am 2004; 86: 1122–1130. Login. Extensors are elevated off th… Conclusions: When an elbow joint is affected by the terrible triad, it is very unstable and prone to numerous complications. USA.gov. The combination of elbow dislocation with both radial head and coronoid process fracture is notoriously challenging to treat and, as such, has been termed ‘‘terrible triad’’ injury of the elbow (TTIE) [1]. And anteromedial coronoid fractures be the mainstays of treatment are controversial: systematic medial collateral ligaments both! Medial and lateral incisions ; medial approach will be required if a large, repairable radial head is in way! S fractures in terrible triad of the elbow consists of bones, ligaments, tendons, and are generally by... 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