ABSTRACT
Abstract Objective To evaluate the functional results of patients submitted to a surgical approach for the treatment of the terrible triad of the elbow, analyzing the treatment methods used and associated epidemiological variables. Methods Patients who underwent surgical treatment for the terrible triad of the elbow from February 2018 to June 2020 at our service were evaluated. The identified sample consisted of 17 patients, but of these, only 13 completed all stages of the study and, therefore, were considered as the universe to be considered. Epidemiological information of interest was collected: age, sex, hand of dominance, affected side, characteristics and classification of injuries, trauma mechanism, time to surgery, type of procedure performed and range of motion. The Mason classification was used for radial head fractures and the Regan and Morrey classification for the coronoid process. In order to perform a functional analysis, the DASH and BRUCE questionnaires were applied. Results About 77% of the patients were male, 92% of the fracture mechanisms were due to high-energy trauma. Contrary to this, the predominance of the non-dominant side was observed as the most affected. Evaluating the results according to the time to start the treatment, the patients operated within 14 days had statistically better functional results. Conclusion Surgical treatment of TTIE generates acceptable functional results in most cases. The success of the treatment is related to the time interval between the trauma and the first surgery, in addition to the severity of the injuries.
Resumo Objetivo Avaliar os resultados funcionais dos pacientes submetidos a abordagem cirúrgica para o tratamento da tríade terrível do cotovelo, analisando os métodos de tratamento utilizados e variáveis epidemiológicas associadas. Métodos Foram avaliados pacientes submetidos aotratamento cirúrgico de tríade terrível do cotovelo de fevereiro de 2018 a junho de 2020 em nosso serviço. A amostra identificada foi de 17 pacientes, mas destes apenas 13 concluíram todas as etapas das pesquisas e por isso foram considerados como o universo a ser levado em consideração. Coletou-se informações epidemiológicas de interesse: idade, sexo, dominância, lado acometido, características e classificações das lesões, mecanismo do trauma, tempo para cirurgia, tipo de procedimento realizado e o arco de movimento. Foi utilizada a classificação de Mason para a fratura de cabeça do rádio e a de Regan e Morrey, para o processo coronoide. A fim de realizar uma análise funcional, aplicou-se os questionários de DASH e BRUCE. Resultados Cerca de 77% dos pacientes foram do sexo masculino, 92% dos mecanismos de fratura foram por trauma de alta energia. Contrariamente a esta, observou-se a predominância do lado não dominante como o mais afetado. Avaliando os resultados de acordo com o tempo para início do tratamento, os pacientes operados em até 14 dias obtiveram resultados funcionais estatisticamente melhores. Conclusão O tratamento cirúrgico da TTC gera resultados funcionais aceitáveis na maioria dos casos. O sucesso do tratamento está relacionado ao intervalo de tempo entre o trauma e a primeira cirurgia, além de se relacionar com a gravidade das lesões.
Subject(s)
Humans , Male , Female , Ulna/injuries , Elbow Joint , Elbow Injuries , Radial Head and Neck FracturesABSTRACT
Objective:To analyze the types of ulnar coronoid process fractures in terrible triad injury (TTI) using three coronoid fracture classification systems and to explore the characteristics of coronoid process fractures and compare the reliability of different coronoid process fractures classification systems in TTI.Methods:A retrospective case series study was used to analyze the CT data of 43 patients with typical TTI admitted to First Affiliated Hospital of Fujian Medical University from January 2013 to October 2020. There were 26 males and 17 females, aged from 18 to 88 years [(41.8±15.6)years]. An independent three-dimensional model of the proximal ulna was established using the CT three-dimensional reconstruction technology. The characteristics of the coronoid process fractures were observed. The Regan-Morrey classification, O'Driscoll classification and Adams classification were used to classify the ulnar coronoid process fractures. The reliability of the three classification systems of coronoid fractures was analyzed.Results:The fracture line of the coronoid process was mostly located anterolaterally. Among all patients with ulnar coronoid fractures, there were 17 patients (40%) with type I, 19 (44%) with type II and 7(16%) with type III according to Regan-Morrey classification; there were 34 patients (79%) with type I, 2(5%) with type II and 7(16%) with type III according to O'Driscoll classification; there were 12 patients (28%) with type I, 3(7%) with type II, 7(16%) with type III, 18(42%) with type IV AL and 2(5%) with type IV AM according to Adams classification. Through reliability analysis, the Kappa coefficients of the inter-observer and intra-observer 1, 2, 3 of Regan-Morrey classification were 0.752, 0.813, 0.772 and 0.703, respectively; the Kappa coefficients of the inter-observer and intra-observer 1, 2, 3 of O'Driscoll classification were 0.797, 0.774, 0.837 and 0.775, respectively; the Kappa coefficients of the inter-observer and intra-observer 1, 2, 3 of Adams classification were 0.805, 0.835, 0.837 and 0.875, respectively.Conclusions:Most of the coronoid process fractures locate anterolaterally in TTI. Compared with Regan-Morrey classification and O'Driscoll classification, the reliability of Adams classification is best. Adams classification further subdivides the anterolateral fractures of the coronoid process, which may be more suitable in evaluating the classification of ulnar coronoid process fractures in TTI.
ABSTRACT
PURPOSE@#To assess the clinical and radiographic outcomes of coronoid process fractures surgically managed with buttress plate fixation via a medial approach.@*METHODS@#A retrospective review of all coronoid fractures surgically fixed in our institution using a buttress plate technique via a medial approach between June 2012 and April 2015 by the senior author was performed. These fractures were all sizeable fractures contributing to persistent elbow instability in terrible triad or varus posteromedial rotatory instability injury patterns. A prospective telephone questionnaire was conducted to assess patient outcomes using the disabilities of the arm, shoulder and hand (DASH) score and Mayo hlbow performance score (MEPS).@*RESULTS@#Twelve patients were included in the study, comprising 10 males and 2 females with an average age of 39 years (range, 19-72 years). Mean follow-up was 16 months (range, 4-18 months). The average time to radiographic union was 4 months (range, 3-7 months). Range of motion measurements at final follow-up were obtained in 11 out of 12 patients, with one patient defaulting follow-up. All 11 patients displayed a functional elbow range of motion of at least 30°-130°, with an average arc of motion of 130° (range, 110° -140°), mean elbow flexion of 134° (range, 110° -140°) and mean flexion contracture of 3° (range, 0° -20°). The mean DASH score was 16 (range, 2.5-43.8) and the mean MEPS was 75 (range, 65-100). Complications observed included one patient with a superficial wound infection which resolved with a course of oral antibiotics and one patient with radiographic evidence of heterotopic ossification which was conservatively managed. No residual elbow instability was observed and no reoperations were performed.@*CONCLUSION@#Buttress plate fixation via a medial approach of coronoid process fractures that contribute to persistent elbow instability represents a reliable method of treatment that produces satisfactory and predictable outcomes.