Posterior dislocation of the elbow with radial head and ulnar coronoid fractures(terrible triad):a report of 5 cases / 中国矫形外科杂志

ABSTRACT

[Objective]To introduce the new concept of "terrible triad of the elbow",and report the preliminary results of 5 clinical cases.[Method]From April 2004 to March 2007,five cases met the diagnosis of terrible triad,with posterior dislocation of elbow complicated with radial head and ulnar coronoid fractures.The radial head fractures were 4 in type Ⅱ and I in type Ⅲ according to Mason classification,and Ⅰ in type Ⅰ,Ⅲ in type Ⅱ and 1 in type Ⅲ according to Schatzker classification.The ulnar coronoid fractures were Ⅰ in type Ⅰ,Ⅳ in type Ⅱ according to Regan-Morrey classification,and all 5 in type Ⅰ according to O'Driscoll classification.Four patients underwent surgical operations.The fractured radial head and ulnar coronoid were reduced and fixed with 3mm titanic lag screws or K wires,the lateral and medial collateral ligaments were repaired with Krachow sutures.A plaster of Paris was applied for 3 weeks after operation,in position with elbow flexion in 90 degrees and forearm rotation in neutral.Then physical exercise and rehabilitation program were carried out.[Result]Four operated patients were followed up for 3 months to 3 years,with healed fractures,stable elbow and no pain movement.The average range of elbow flexion-extension were 120 degrees,and forearm pronationsupination were 110 degrees,respectively.The functional outcome in 3 cases that followed up more than Ⅰ year was excellent in 2 and good in Ⅰ according to Mayo Elbow Performance Score(MEPS).The result of the un-operated case was poor in MEPS evaluation.Elbow instability and pain was the main complaint.[Conclusion]Terrible triad of posterior dislocation with radial head and ulnar coronoid fractures is a severe trauma to the elbow.Operative osteosythesis and ligament repair is mandatory for concentric reduction and elbow stability.