Replacement or repair of terrible triad of the elbow: A systematic review and meta-analysis. Dr reports a "Terrible Triad Injury" which is, per the Op Note, Radial head fx, coroniodprocess avulsion fx and collateral ligament disruption. [Medline] . Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. For terrible triad injuries, radial head arthroplasty afforded the ability to obtain elbow stability with comparable overall outcomes when compared to ORIF. [3] The most challenging of these problems is recurrent subluxation or dislocation. Diagnosis. It is a complex trauma, associating … However, 11 patients who underwent arthroplasty demonstrated radiographic signs of arthrosis compared to none in the ORIF group (p = 0.04). Equipment. Patients were managed with a standard algorithm consisting of (1) repair (n = 9) or replacement (n = 30) of the radial head, (2) repair of the lateral ulnar collateral ligament, and (3) repair of the coronoid fracture. eCollection 2020. Terrible triad injuries account for approximately 30% of all elbow dislocations. Dislocation with Articular Fracture . eCollection 2020 Dec. Kodde IF, Viveen J, The B, van Riet RP, Eygendaal D. EFORT Open Rev. were the first to introduce it to China in 2005 6. [ 3 – 8 , 25 ] Pugh et al [ 3 ] repaired the MCL in 6 (17%) of 36 patients with terrible triad elbow injuries, and only in cases where the patients showed residual posterior instability after repair. <>stream The “terrible” designation of these injuries is due to the fact that the elbow has lost all ligamentous and bony stability, leading to a high rate of recurrent instability if left untreated. A bump is placed under the…, ( A ) AP and ( B ) lateral radiographs show a 22…, NLM O'Donoghue estimated the incidence rate in the traumatic sports knee to be 25%. 2020 Mar 19;54(Suppl 2):254-259. doi: 10.1007/s43465-020-00090-x. In 1950, O'Donoghue described the unhappy triad as: (1) rupture of the medial collateral ligament, (2) damage to the medial meniscus and (3) rupture of the anterior cruciate ligament. Dislocation of the elbow associated with radial head and coronoid fracture, the so-called "terrible triad" of the elbow, is challenging to treat and has a history of complicated outcomes. The “terrible triad injury” of the elbow, as named by Hotchkiss, is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture The main objective in the management of such injuries is to restore the stabilizing bony structures of the elbow to convert a complex dislocation of the elbow joint into a simple one. Elbow held in 45 degree of flexion; Olecranon is prominent posteriorly Looking for the second injury: the coronoid process fracture and the “terrible triad” In suspected radial head and neck injuries, make sure to examine the coronoid process, or the anterior proximal portion of the ulna. All patients who underwent radial head arthroplasty at the index procedure had a stable elbow at final followup whereas three of nine patients who underwent ORIF were unstable (p = 0.009). With the numbers available, there was no difference in reoperation rate between groups (p = 0.45). 2018 Aug;46(8):3053-3064. doi: 10.1177/0300060518771263. Share. As to terrible triad injury of elbow joint, because of the complexity of the surrounding anatomy of the elbow joint, the limited biomechanical study, the difficult treatments, and the poor prognosis, the choice of the treatment scheme is Indian J Orthop. Abstract: Operative treatment for complex elbow injuries has evolved. Background: CONCLUSIONS: For terrible triad injuries, radial head arthroplasty afforded the ability to obtain elbow stability with comparable overall outcomes when compared to ORIF. �),�@�3���`�b�Є%�����P�qd�C�7. 2014 Jul;472(7):2075-83. doi: 10.1007/s11999-014-3475-3. Clin Orthop Relat Res. Hotchkiss introduced this concept 1996 5; Zhang et al. ANYWAY, my elbow is 100% healed…it hasn’t caused me any inconvenience or pain in the longest time. Stability should be evaluated intraoperatively after reconstruction. - Management of Complex Elbow Dislocations: - dislocation w/ radial head frx - terrible triad - Complications: - valgus instability: - patients will show a variable amount of MCL laxity which correlates with a worse clinical and radiographic result; - to maximize the stress on the medial collateral ligament, the forearm should be placed in full pronation, which Authors of section Editors. Journal of Orthopaedic Surgery endobj 2020 Jan 28;4(12):659-667. doi: 10.1302/2058-5241.4.180099. Specifically, the question of whether to repair or replace the radial head remains controversial. Fracture dislocation of the elbow, termed terrible triad, involves three anatomic injuries: coronoid fracture, radial head fracture, and posterior elbow dislocation. 472 (7):2128-35. Prediction and Potential Preventions for the Development of Posttraumatic Osteoarthritis after the Terrible Triad Injury: A Multicenter Risk Factors Study. "Terrible Triad" injury describes unstable joint consisting of: Elbow dislocation; Radial head fracture; Coronoid fracture; Clinical Features. A bump is placed under the humerus with the elbow extended and forearm supinated. 1 0 obj Patterns of Traumatic Elbow Instability With Fracture . Relatively few studies have documented the outcomes of terrible triad injuries of the elbow. [Progress in treatment of terrible triad of elbow]. Epidemiology. 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. 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