Diagnosis. View This Abstract Online Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis? <>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/TrimBox[0 0 595.27600 841.89001]>> Hotchkiss introduced this concept 1996 5; Zhang et al. As to terrible triad injury of elbow joint, because of the complexity of the surrounding anatomy of the elbow joint, the limited biomechanical study, the difficult treatments, and the poor prognosis, the choice of the treatment scheme is [Progress in treatment of terrible triad of elbow]. Management of the failed radial head arthroplasty. Fracture of the anteromedial facet of the coronoid process with injuries to the anterior and posterior bundles of the ulnar collateral ligament and to the lateral ligaments, consistent with varus posteromedial rotatory instability of the elbow (PMRI). Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach J Int Med Res . 1,2 The injury consists of a 336 R Seijas et al. Stability should be evaluated intraoperatively after reconstruction. Choose treatment. For terrible triad injuries, radial head arthroplasty afforded the ability to obtain elbow stability with comparable overall outcomes when compared to ORIF. 5.2 3-Dimensional reconstruction CT scan of a right elbow with a terrible triad injury, as viewed (a) laterally and (b) medially The individual components of… Epub 2015 Oct 1. terrible triad of the elbow.6,7 Its prognosis remains uncertain, especially over the long term.6 The objective of the present study was to evaluate the results from surgical treatment of the terrible triad of the elbow, with at least six the In this review, the classiﬁcation, treatment principles and prognosis for different forms Peter Trafton, Michael Baumgaertner. doi: 10.1097/MD.0000000000013054. Clipboard, Search History, and several other advanced features are temporarily unavailable. Viveen J, Kodde IF, Heijink A, Koenraadt KLM, van den Bekerom MPJ, Eygendaal D. EFORT Open Rev. Results: Terrible triad injuries of the elbow: does the coronoid always need to be fixed? This objective remains a challenge for surgeons due to the complexity of the lesion.5 The injury is characterized by elbow instability and development of arthrosis and joint stiffness. The 'terrible triad of the elbow' refers to a combination of elbow dislocation and radial head and coronoid process fracture - it is notoriously difficult to manage although a systematic review found that whilst complications are common, functional outcomes are generally satisfactory . Complications of terrible triad surgical treatment include heterotopic ossification, stiffness, nerve injury, and recurrent subluxation or dislocation of the elbow. Specifically, the question of whether to repair or replace the radial head remains controversial. Elbow held in 45 degree of flexion; Olecranon is prominent posteriorly Because case series are relatively small, it is difficult to estimate the incidence of complications. Terrible Triad Injury の治療経験 - 60 - 【症 例】 症例10．38 歳，男性．転落し左肘を受傷した． X 線およびCT 上，鉤状突起骨折はRegan 分類type IIB，O’Driscoll 分類type I subtype 2，橈骨頭骨折は IV 型の粉砕 … Elbow extension with forearm supination and added valgus stress puts most strain on the ulnohumeral joint, radial head and MCL respectively, causing a posterolateral rotational instability pattern of fracture-dislocation which includes posterior dislocation with a radial head fracture and the terrible triad injury with an added coronoid fracture. [ 3 – 8 , 25 ] Pugh et al [ 3 ] repaired the MCL in 6 (17%) of 36 patients with terrible triad elbow injuries, and only in cases where the patients showed residual posterior instability after repair. The weight of the hand and forearm acts as a dislocating force in this position of maximal instability. - Management of Complex Elbow Dislocations: - dislocation w/ radial head frx - terrible triad - Complications: - valgus instability: - patients will show a variable amount of MCL laxity which correlates with a worse clinical and radiographic result; - to maximize the stress on the medial collateral ligament, the forearm should be placed in full pronation, which T Select Management. BACKGROUND: The terrible triad of the elbow comprises an ulnar coronoid process fracture, a radial head (RH) fracture and posterior dislocation of the elbow. Capitellum fractures are uncommon, but their prompt diagnosis and management are crucial due to the severity of the consequent functional impairment resulting from these intra-articular elbow fractures. 3), and is often associated with collateral ligaments injuries. Share. However, 11 patients who underwent arthroplasty demonstrated radiographic signs of arthrosis compared to none in the ORIF group (p = 0.04). Replacement or repair of terrible triad of the elbow: A systematic review and meta-analysis. Anterior . A photograph demonstrates the hanging arm test. 2020 Jun 21;2020:6508781. doi: 10.1155/2020/6508781. A delay in treatment or revision surgery resulted in a 20% greater loss of … Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. "Terrible Triad" injury describes unstable joint consisting of: Elbow dislocation; Radial head fracture; Coronoid fracture; Clinical Features. But if … Clin Orthop Relat Res. 2013. A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. In the realm of orthopaedics, the terrible triad of the elbow is infamous, not simply because the prognosis is poor for most patients, but also, maybe to a greater extent, because the unique name of this malady attracts considerable attention and interest in both doctors and patients. 2014; 472(7):2128-35 (ISSN: 1528-1132) Watters TS Varus posteromedial rotational instability . During the study period, the radial head generally was internally fixed when there were fewer than four articular fragments; otherwise, it was replaced. Please enable it to take advantage of the complete set of features! CONCLUSIONS: For terrible triad injuries, radial head arthroplasty afforded the ability to obtain elbow stability with comparable overall outcomes when compared to ORIF. Clin Orthop Relat Res. 2020 Aug 1;5(7):398-407. doi: 10.1302/2058-5241.5.190055. were the first to introduce it to China in 2005 6. A diagram outlines the treatment algorithm used for radial head management in the…, A photograph demonstrates the hanging arm test. Most cases require surgery and a recovery period of six to nine months. Level of evidence: The “terrible” designation of these injuries is due to the fact that the elbow has lost all ligamentous and bony stability, leading to a high rate of recurrent instability if left untreated. Evaluation included the DASH score, the Broberg-Morrey index, measurements of elbow stability and motion, and radiographic assessment for signs of arthrosis; chart review was performed for complications and reoperations. MCL avulsion is likely to be present in many terrible triad injuries, and there is no consensus as to the need for a medial exposure in a terrible triad injury. Terrible triad injuries account for approximately 30% of all elbow dislocations. The individual components of the terrible triad can be individually classified to aid in the evaluation of this injury: Fractures of the Radial Head The radial head is an important secondary stabilizer of the elbow to valgus stress and the radiocapitellar joint … Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. eCollection 2019 Dec. Medicine (Baltimore). 1 and 5 Surgical treatment is the therapy of choice in the vast majority of cases, with the aims of restoration of the anatomy and early mobility. | The most challenging of these problems is recurrent subluxation or dislocation. We compared patients with terrible triad injuries of the elbow whose radial head fracture was treated with either internal fixation and internal fixation (ORIF) or radial head arthroplasty in terms of (1) clinical outcome measures (DASH and Broberg-Morrey scores, ROM), (2) elbow stability and radiographic signs of arthrosis, and (3) complications and reoperation rates. Li J, Lu D, Lin W, Li Q, Hu J, Xu D, Zhao Y, Guo W. Biomed Res Int. Specifically, the question of whether to repair or replace the radial head remains controversial. Open reduction internal fixation.