In-depth discussion on the treatment of terrible triad of the elbow / 中国组织工程研究

BACKGROUND: The diagnosis and treatment of the terrible triad of the elbow have achieved a breakthrough. OBJECTIVE: To introduce the definition, basic anatomy, stable structure, injury mechanism and classification of terrible triad of the elbow, and to discuss the treatment plan deeply. METHODS: The first author searched PubMed, CNKI and Wanfang databases for the articles published before September 2019. The keywords were “terrible triad of the elbow, elbow joint, fracture dislocation” in English and Chinese, respectively. A large number of articles concerning the terrible triad of the elbow in recent years were reviewed, and the treatment strategy was summarized. RESULTS AND CONCLUSION: For the terrible triad of the elbow, the operator must carefully check the patient before operation, carefully analyze the imaging examination results and three-dimensional printed model, and accurately judge the bone structure of the elbow and degree of ligament injury. During the operation, the stability of the radial head, the fracture of the coronoid process and the injury of the lateral ligament complex are usually reconstructed through a single lateral approach or a combination of internal and external approaches. Then, the stability of elbow joint is tested to determine whether it is necessary to repair the medial ligament complex or use the hinged external fixator to restore the stability of elbow joint. Early active rehabilitation is needed. The above systematic treatment can reduce postoperative complications, accelerate fracture healing, and improve elbow joint function and patients’ quality of life.

A study on the repairment of the collateral ligament of terrible triad of the elbow under hinged external fixator / 医学研究生学报

Objective The application of hinged scaffold in the terrible triad of the elbow has been widely accepted by or-thopedic trauma physicians. We discussed whether to repair the collateral ligament or not of terrible triad of the elbow under hinged ex-ternal fixator in this study. Methods 23 patients with terrible triad of the elbow,who had been admitted in Foshan Hospital of tradi-tional Chinese Medicine from June 2011 to August 2016 were selected. In the surgeries, we firstly repaired and fixed the coronoid and radial head fractures,and the repairments of the lateral collateral ligament complex(LCLC) was based on the severity of injury and the stability of the elbow joint. All the patients were treated with hinged external fixator in flexion 90°,forearm neutral position and the medial collateral ligament complex (MCLC) was not repaired. The patients were followed up from 8 to 26 months with an average of 13.7 months. Elbow flexion and extension amplitude and forearm rotation amplitude were measured at the time of follow-up. The clinical effects were eval-uated according to HSS scoring of elbow joint function. Results Their average elbow range of flexion and extension at the last follow-up is (122.2 ± 11.9)°,LDLC insertion site reconstruction and non-reconstruction has the flexion and extension range of (120.3 ± 13.1)°,(125.6±9.0)°;their average forearm rotation amplitude was(118.7±14.3)°,LDLC insertion site reconstruction and non-re-construction has the forearm rotation amplitude of (116.0±13.1)°,(123.8±16.0)°. HSS score was (82.0±12.6) points.The results were excellent in 7 cases,good in 11. The excellent-good rate was 78.3%. After surgery,1 case developed radial head subluxation,1 case developed nonunion of radial head without recurrent dislocation of elbow joint,6 cases developed ectopic ossification of the elbow joint. Conclusion With the use of hinged external fixator,it is not necessary to repair the MCLC. And the LCLC injury cannot be repaired when it does not cause severe instability of the elbow,with the use of hinged external fixator can get a good effect.

Surgical treatment for terrible triad of the elbow through medial and lateral approach / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the clinical effects of medial and lateral approach in treating terrible triad of the elbow.</p><p><b>METHODS</b>From May 2010 from May 2014, 11 patients with terrible triad of the elbow were treated through medial and lateral approach. There were 6 males and 5 females, aged from 25 to 56 years with an average of 35.2 years old. The time from injury to operation was from 1 to 13 days with an average of 5.9 days. Fracture of radial head according to Mason typing, 2 cases were type I, 7 cases were type II, 2 cases were type III. Ulnar coronoid fracture according to Regan-Morrey typing, 3 cases were type I, 7 cases were type II, 1 case was type III. Postoperative complications were observed and Mayo elbow performance score(MEPS) was used to assess the elbow joint function.</p><p><b>RESULTS</b>All patients were followed up from 6 to 24 months with an average of 15.5 months. All fractures obtained healing with an average time of 14 weeks (ranged from 10 to 18 weeks). According to Mayo to assess the results, total score was 78.2±11.7, 2 cases got excellent results, 7 good, 1 fair, 1 poor. At final follow up, the mean range of motion was (108±21)° in flexion, (12±8)° in extension, (66±13)° in pronation, (28±18)° in supination. The varus angle of the elbow ranged from 5°to 8° in 3 cases and the valgus angle was 8° in 1 case.</p><p><b>CONCLUSIONS</b>Treatment of the terrible triad of the elbow through medial and lateral approach can obtain satisfactory clinical effects, restore the elbow stability, allow early motion postoperatively, and promote the joint functional rehabilitation.</p>