Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 6 Issue 3

Terrible Triad Fracture Dislocation Injury Review of Current Fixation Protocols and Illustration of Single Incision Technique in 8 cases “Case Series.”

Ayman Ali, Elham A Alghamdi*, Hussain Murad Alkaff, Bander S Alrashedan and Saleh AlMutlaq

Orthopedic Surgery Department, King Saud Medical City, Riyadh, Saudi Arabia

*Corresponding Author: Orthopedic Surgery Department, King Saud Medical City, Riyadh, Saudi Arabia.

Received: January 23, 2023; Published: February 18, 2023

Abstract

Background:: Terrible triad injuries are devastating clinical entities with different approaches described in the literature for fixation. Stability and an ideal range of motion are paramount for a favorable clinical outcome. The purpose of the study was to review the current protocols and surgical management of this complex injury and to assess the stability and range of motion of eight cases reported.

Methods: Case series of patients involved in a non-salvageable radial head fracture. After surgery, the follow-up period was 27 months. The primary outcome measures were a range of motion and elbow stability intra-operatively and postoperatively. Secondary outcome measures were Mayo elbow performance scores.

Results: Seven patients were included in the study, with a total of eight elbows presented with a terrible triad in our institute between February 2020 and May 2022. All cases reached the desired stability following coronoid repair, radial head replacement, and lateral ulnar collateral ligament repair (LUCL). Range of motion got 10 to 125 degrees on the twelfth week postoperatively. Mayo elbow performance and Disabilities of the Arm, Shoulder, and Hand Questionnaire scores were favorable at the final follow-up, with no chronic instability in all cases.

Conclusion: Single incision using the Kocher approach, coronoid-first fixation using anchor suture is feasible following the removal of a comminuted radial head, followed by radial head replacement and LUCL repair resulting in desirable clinical outcomes. There is no superior current protocol for treating these injuries.

Keywords: Elbow; Trauma; Radial Head; Dislocation; Fixation

References

  1. Hotchkiss RN. “Fractures and dislocations of the elbow”. Fractures in Adults (1996): 929-1024.
  2. O Driscoll SW., et al. “The unstable elbow”. Instructional Course Lectures-American Academy of Orthopaedic Surgeons 50 (2011): 89-104.
  3. Pugh DM and McKee MD. “The “terrible triad” of the elbow”. Techniques in Hand and Upper Extremity Surgery 6.1 (2002): 21-29.
  4. Leigh WB and Ball CM. “Radial head reconstruction versus replacement in the treatment of terrible triad injuries of the elbow”. Journal of Shoulder and Elbow Surgery 21.10 (2012): 1336-1341.
  5. Zeiders GJ and Patel MK. “Management of unstable elbows following complex fracture-dislocations-the “terrible triad” injury”. JBJS 90.4 (2008): 75-84.
  6. Motisi M., et al. “Trends in management of radial head and olecranon fractures”. The Open Orthopaedics Journal 11 (2017): 239.
  7. Morrey BF and An KN. “Stability of the elbow: osseous constraints”. Journal of Shoulder and Elbow Surgery 14.1 (2005): S174-S178.
  8. Ohl X and Siboni R. “Surgical treatment of terrible triad of the elbow”. Orthopaedics and Traumatology: Surgery and Research (2020): 102784.
  9. Kim BS., et al. “Does the coronoid always need to be fixed in terrible triad injuries of the elbow? Mid-term postoperative outcomes following a standardized protocol”. Journal of Clinical Medicine 9.11 (2020): 3500.
  10. Papatheodorou LK., et al. “Terrible triad injuries of the elbow: does the coronoid always need to be fixed?”. Clinical Orthopaedics and Related Research® 472.7 (2014): 2084-2091.
  11. Antoni M., et al. “Anterior capsule re-attachment in terrible triad elbow injury with coronoid tip fracture”. Orthopaedics and Traumatology: Surgery and Research 105.8 (2019): 1575-1583.
  12. Hartzler RU., et al. “Transverse coronoid fracture: when does it have to be fixed?” Clinical Orthopaedics and Related Research® 472.7 (2014): 2068-2074.
  13. Beingessner DM., et al. “The effect of suture fixation of type I coronoid fractures on the kinematics and stability of the elbow with and without medial collateral ligament repair”. Journal of Shoulder and Elbow Surgery 16.2 (2007): 213-217.
  14. Yang HS., et al. “Comminuted Radial Head Fracture in All-arthroscopic Repair of Elbow Fracture-dislocation: Is Partial Excision of the Radial Head an Acceptable Treatment Option?” Clinics in Shoulder and Elbow 21.4 (2018): 234.
  15. Zhang J., et al. “Outcomes of coronoid-first repair in terrible triad injuries of the elbow”. Archives of Orthopaedic and Trauma Surgery 137.9 (2017): 1239-1245.
  16. Williams N. “Dash”. Occupational Medicine 64.1 (2014): 67-68.
  17. Cusick MC., et al. “Accuracy and reliability of the Mayo elbow performance score”. The Journal of Hand Surgery 39.6 (2014): 1146-1150.
  18. Thayer MK., et al. “Classifications in brief: Regan-Morrey classification of coronoid fractures”. Clinical Orthopaedics and Related Research 476.7 (2018): 1540.
  19. Iannuzzi NP and Leopold SS. “In brief: the Mason classification of radial head fractures” (2012).
  1. Cage DJ., et al. “Soft tissue attachments of the ulnar coronoid process. An anatomic study with radiographic correlation”. Clinical Orthopaedics and Related Research 320 (1995): 154-158.

Citation

Citation: Elham Ali Alghamdi.,et al. “Terrible Triad Fracture Dislocation Injury Review of Current Fixation Protocols and Illustration of Single Incision Technique in 8 cases “Case Series.””. Acta Scientific Orthopaedics 6.3 (2023): 148-155.

Copyright

Copyright: © 2023 Elham Ali Alghamdi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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