Elbow dislocations are staged depending on the disruption of the following stabilizers: the ulnohumeral articulation, MCL, and LCL. Fitzgibbons et al. Elbow dislocations make up between 11-28% of all elbow injuries. For repairable comminuted coronoid process fractures, the coronoid process should be repaired with relatively larger fracture fragments from the articular facet and the anterior support of the coronoid process should be restored to prevent re‐dislocation of the elbow joint. Bone destruction in the terrible triad injury: the terrible triad of the elbow is defined as a combination of radial head and ulnar coronoid process fractures and the dislocation of the elbow joint. Mild postoperative valgus instability is not an indication for reoperation because it is usually compensatory33. He also pointed out that, because these injuries are commonly seen in younger patients, longer‐term studies are needed to determine whether the apparent benefits of radial head arthroplasty are offset by late complications of arthroplasty, such as loosening. This course of physical therapy successfully treat a undisplaced terrible triad injury in very limited selected supervised patients. Copyright © 2013 Elsevier Inc. All rights reserved. Terrible triad injuries account for approximately 30% of all elbow dislocations. Proposed algorithms on how to optimally manage these injuries are published in the surgeon and therapy literature to assist with the clinical decision-making process in diagnoses such as “terrible triad” injuries. Apart from bony structures, several ligaments also contribute to elbow stability; these include the medial collateral ligament complex (MCLC) and the lateral collateral ligament complex (LCLC). classified coronoid fracture into the following three types according to the distribution of the fracture lines20. Can we treat select terrible triad injuries nonoperatively? Type I are non‐displaced radial head fractures (or small marginal fractures); Type II are partial articular fractures with displacement (>2 mm); Type III are comminuted fractures involving the entire radial head; and Type IV are fractures of the radial head with dislocation of the elbow joint. A posterior skin incision that allows accesses to both medial and lateral aspects of the elbow is most widely chosen. USA.gov. ANYWAY, my elbow is 100% healed…it hasn’t caused me any inconvenience or pain in the longest time. (A) Medial view of the elbow bone structures. Replacement or repair of terrible triad of the elbow: A systematic review and meta-analysis. Radial head fixation and arthroplasty, coronoid process fixation, and repair of the lateral collateral ligament continue to be the mainstays of treatment. Risk factors of efficacy for patients receiving surgical treatment following terrible triad of the elbow joint: A comparative study. All four patients treated by resection of the radial head re‐dislocated after operative treatment, whereas four of the five patients who underwent radial head repair achieved satisfactory prognoses with follow‐up of two to seven years. Pre-operatively on the ward • Discuss post -operative rehab ’ The full text of this article hosted at iucr.org is unavailable due to technical difficulties. TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT. The mean Mayo elbow performance scores were 95 points after a 32 months follow‐up (19 cases ranked excellent and two ranked good), and the mean flexion and mean rotation arcs were 126° and 139°, respectively42. In terrible triad injuries, injury of the LCLC often occurs at its origin at the lateral condyle of the humerus; other parts of the LCLC tear less frequently31. Lateral Approach Versus Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis. Number of times cited according to CrossRef: Analysis of twenty-five cases of terrible triad injury of the elbow surgically treated with a single lateral approach. To answer such these questions, the relevant basic anatomical features of the elbow joint are described first, after which we dive deeper into its definition, classification and treatment principles. Therefore, patients and even doctors may harbor doubts about what this so‐called terrible triad is, just how terrible it is, and whether it is possible to achieve a satisfactory prognosis. Elbow Dislocation Rehabilitation Protocol Elbow Dislocation The Elbow Joint is the most complex joint in the body. Hartzler et al. Improved experience, techniques, and implants have advanced to the point where restoration of elbow stability can be expected. There are very few articles about terrible triad recovery for the elbow. If instability persists, hinged external fixation should be applied35. Attempts should be made to to preserve the radial head, otherwise radial head arthroplasty should be performed. Thus the term “terrible triad of the elbow’ has morphed into a readily recognized symbol that has somewhat lost its significance. treatment of the “terrible triad of the elbow”. This injury is commonly seen in accidents that involved great force, such as vehicle crashes or falls from heights. Physical therapy after the surgery and the use of a knee brace help speed up the healing process. The adjective terrible is bestowed on an elbow triad that comprises three coexisting complicated traumas; namely, radial head and ulnar coronoid process fractures and posterior dislocation of the elbow joint. Careful attention to each destabilizing element of the injury pattern is essential and places high demands on the surgeon's mastery of the anatomic complexity of the elbow. performed a meta‐analysis of 312 such cases and reported satisfactory functional outcomes with Mayo elbow performance scores of 78–95 points, the Broberg–Morrey scores of 76–90 points and DASH scores of 9–31 points39. Type I are non‐displaced or minimally displaced fractures of the head or neck, intra‐articular displacement is usually <2 mm or they are marginal lip fractures; Type II are displaced (usually >2 mm) fractures of the head or neck (angulated) in which motion is characteristically mechanically blocked or incongruous, these can usually be fixed surgically; and Type III are severely comminuted fractures of the radial head and neck, for which radial head excision or replacement is needed. Possible postoperative joint stiffness, prosthesis removal or ulnar nerve symptoms may require additional procedures; however, arthritis is usually tolerable. Fractures of the coronoid process of the ulna, Difficult elbow fractures: pearls and pitfalls, Distribution of coronoid fracture lines by specific patterns of traumatic elbow instability, Management of unstable elbows following complex fracture‐dislocations—the “terrible triad” injury, Current concepts in the management of complex elbow trauma, Reconstruction of the coronoid using an extended prosthesis: an, Reconstruction of the coronoid process with iliac crest bone graft in complex fracture‐dislocation of elbow, Reconstruction of the coronoid process with iliac crest bone graft. Pathology Whether elbow stability has been achieved should be checked intraoperatively after repairing the coronoid process, radial head and LCLC. The fractures are further subclassified into A and B groups according to whether the patient does or does not have elbow joint dislocation. have reported that almost all patients with dislocation of the elbow joint have some degree of tearing of the MCLC and LCLC9. The terrible triad of the elbow is a severe elbow fracture-dislocation pattern and is so-called because it has poor medium-to-long term outcome.. Clipboard, Search History, and several other advanced features are temporarily unavailable. Computed tomography with three dimensional reconstructions can be helpful in ascertaining the type of injury. Residual instability was only seen in the physical examination in 7 elbows (33%), but none of these patients were symptomatic. The anterior band of the MCLC plays an essential role in valgus stability of the elbow33, whereas the posterior band of the MCLC is critical in maintaining elbow posterolateral rotation stability34. 8However, with modern knowledge of injury patterns and improved fracture-fixation methods, reasonable, if not perfect, results can be anticipated. | Methods: Eight patients identiﬁed with “terrible triad” injury patterns, including posterior elbow dislocation, radial head fracture and coronoid fracture, were available for a minimum of 11 months follow-up. 10 Anatomically, The short-term and long term results are historically poor, with a … According to the Mason–Johnson classification, there are four types of radial head fractures10. A radiographic study of 422 patients, Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow, Posterolateral rotatory instability of the elbow, Fracture‐dislocation of the elbow functional outcome following treatment with a standardized protocol, Results of terrible triads in the elbow: the advantage of primary restoration of medial structure. Please enable it to take advantage of the complete set of features! Of these type I fractures are most commonly associated with the terrible triad injury19. Terrible triad of elbow joint is a severe traumatic injury to elbow joint and this injury makes elbow joint very unstable. The treatment of terrible triad injuries of the elbow continues to evolve. When the patient is deemed medically fit, surgery is indicated for failure to meet nonsurgical treatment criteria, for open wounds, and/or for neurologic or vascular injury. Fig. retrospectively reviewed 11 cases of terrible triad injuries with a mean postoperative follow‐up of 38 months and reported no instances of elbow instability; mean disabilities of the arm, shoulder and hand (DASH) scores being 19.7 points, mean visual analog scale 2.2 points and average flexion arcs 112° at the end of follow‐up41. A definition of primary and secondary constraints, Outcomes after terrible triads of the elbow treated with the current surgical protocols. Epidemiology. were the first to introduce it to China in 20056. Risk factors of efficacy for patients receiving surgical treatment following terrible triad of the elbow joint. proposed repairing and fixing the radial head by Kirschner wire to re‐establish elbow stability rather than implementing radial head resection at an early stage13. Elbow Trauma Rehabilitation Protocol Includes post ORIF, or conservatively managed trauma when active ROM indicated N.B. 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