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Terrible triad

Taku Hatta, Shingo Nobuta, Toshitake Aizawa, Koichi Sasajima, Soichi Nakajima, Masahito Honda, Gosuke Oki, Yoshiaki Yamanaka, Eiji Itoi
The aim of our study is to evaluate the clinical and radiologic outcomes in patients with terrible triad injury, who underwent surgical treatment with or without the medial collateral ligament (MCL) repair. Fourteen patients who underwent surgery with a minimum of 12-month follow-up (mean, 17 months) were reviewed. Based on the systematic treatment protocol, radial head fracture, lateral collateral ligament, and coracoid fracture were treated. Subsequently, torn MCL was repaired in 7 patients, whereas in the remaining 7 patients, the MCL was not treated...
September 19, 2016: Orthopedic Reviews
Hong Wu, Qiande Liao, Yong Zhu, Hua Liu
The terrible triad injury of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture. In this study, we explored the outcome of a modified protocol for terrible triad injury of the elbow in a consecutive series of 14 patients, with a focus on reconstruction of comminuted coronoid fractures. Fourteen patients with terrible triad injuries of the elbow were retrospectively reviewed at a mean follow-up of 23 months (range, 15-30 months) and were clinically and radiographically evaluated...
December 2012: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Dafang Zhang, Matthew Tarabochia, Stein Janssen, David Ring, Neal Chen
OBJECTIVE: The management of terrible triad injuries has evolved over the last two decades to include routine radial head fixation or replacement, reattachment of the LCL, with or without coronoid fixation. Our objective was to determine the likelihood of and factors associated with subluxation or dislocation after operative treatment of terrible triad injuries among a large group of surgeons using current techniques. DESIGN: Retrospective cohort study SETTING:: Two Level I trauma centers PATIENTS/PARTICIPANTS:: A total of 107 patients with operatively treated terrible triad injuries from January 2000 to June 2015...
July 29, 2016: Journal of Orthopaedic Trauma
You Zhang, Shiqing Liu, Hongbin Zhou, Xiaorong Qin, Xiangwei Zhang
OBJECTIVE: To investigate the feasibility of modified classification of terrible triad of the elbow and the effectiveness of treatment strategy which was chosen by modified classification results. METHODS: Between March 2007 and November 2013, 12 cases of terrible triad of the elbow were treated by operation. There were 5 males and 7 females with an average age of 37.2 years (range, 26-74 years). The mechanism of injury was falling from height in 8 cases and traffic accident in 4 cases...
March 2016: Chinese Journal of Reparative and Reconstructive Surgery
Graeme Whyte, Andrew Rokito
Anterior shoulder dislocation in the athlete may result in an assortment of injuries that often benefit from surgical stabilization procedures. These injury patterns can be complex, requiring a multimodal approach to treatment. We present a rare case of a traumatic anterior shoulder dislocation in a teenage athlete that resulted in humeral avulsion of the glenohumeral ligament, rotator cuff tear, and axillary nerve palsy. Surgical treatment enabled return to football within 1 year of injury, and full function was restored...
June 2016: Bulletin of the Hospital for Joint Diseases
Pietro Poglia, Laurent Wehrli, Sylvain Steinmetz, Philippe Zermatten
BACKGROUND: The combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture is known as "terrible triad" injury of the elbow. This injury is one of the most challenging injuries of the musculoskeletal system and almost always causes instability of the elbow. The use of an adjuvant hinged external fixator in such injuries is still debated. CASE PRESENTATION: In this case report we present a case of radial nerve palsy after setting up an adjuvant hinged external fixator in a complex fracture-dislocation of the elbow...
2016: Journal of Medical Case Reports
Y J Zha, X Y Jiang, M Q Gong
OBJECTIVE: To introduce the surgical techniques and treating results of the old "terrible triad" of the elbow. METHODS: A retrospective analysis of 11 cases of old "terrible triad" of the elbow treated by the author from March 2009 to February 2014 were performed, with 9 males and 2 females; mean age was (31.82±8.66) years (17-45 years). The average time after injury was (6.36±2.50) weeks (4-12 weeks), with 7 cases on the left and 4 right. The combined injury included 2 cases with distal radius fractures, 1 with ankle fractures, fractures of the distal radius and the head injury (minor epidural hematoma, no surgery), and 1 with Pilon fractures and L4 fractures (fixed at local hospital)...
April 18, 2016: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
Jonathan P Marsh, Ruby Grewal, Kenneth J Faber, Darren S Drosdowech, George S Athwal, Graham J W King
BACKGROUND: Radial head arthroplasty is commonly used to treat acute unreconstructible radial head fractures. The purpose of this study was to report on the clinical and radiographic outcomes at a minimum follow-up of five years after radial head arthroplasty with a modular metallic implant for the treatment of acute radial head fractures. METHODS: The cases of fifty-five patients with unreconstructible radial head fractures treated acutely with a smooth-stemmed modular metallic radial head implant were retrospectively reviewed...
April 6, 2016: Journal of Bone and Joint Surgery. American Volume
Koji Sukegawa, Takane Suzuki, Yasufumi Ogawa, Keisuke Ueno, Hitoshi Kiuchi, Aya Kanazuka, Yusuke Matsuura, Kazuki Kuniyoshi
BACKGROUND: The extensile extensor digitorum communis (EDC) splitting approach can access the ulnar coronoid process (UCP), which can be used to treat terrible triad injuries. The present study anatomically examined the extensile EDC splitting approach for exposing the UCP. METHODS: Twenty fresh frozen cadaveric upper limbs were dissected. The splitting length of the EDC and detachment length of the extensor carpi radialis brevis (ECRB)-extensor carpi radialis longus (ECRL)-brachioradialis (BR) origin were measured to expose the UCP...
August 2016: Journal of Shoulder and Elbow Surgery
Leandro Cardoso Gomide, Dagoberto de Oliveira Campos, José Maria Ribeiro de Sá, Marcelo Rangel Pamfílio de Sousa, Thiago Correa do Carmo, Fernando Brandão Andrada
OBJECTIVES: To evaluate the epidemiology of and surgical results from treating elbow fracture-dislocations, including only the cases in which dislocation is associated with fracture of the coronoid process and the radial head (terrible triad). METHODS: Nineteen patients were evaluated: 12 males and 7 females. The medical records were analyzed to gather data about the mechanism of injury, fracture pattern, time elapsed until surgery and type of procedure applied...
July 2011: Revista Brasileira de Ortopedia
Kevin Chan, Graham J W King, Kenneth J Faber
Successful management of complex elbow fracture-dislocations requires, in part, recognition of the overall injury pattern, which can aid in the identification of concomitant bony and soft tissue injuries. Trans-olecranon fracture-dislocations are best treated surgically with stable anatomic restoration of the trochlear notch. Terrible triad elbow injuries are believed to be caused by a valgus posterolateral force. Although select terrible triad injuries can be managed non-operatively, the majority of injuries are treated with stable surgical repair to allow early elbow motion...
June 2016: Current Reviews in Musculoskeletal Medicine
Vishal Kumar, Avinash Kumar, Sameer Aggarwal
Radial head and coronoid fractures without posterior dislocation of the elbow have not been recorded in the literature. There is no literature documenting the combined fractures of the radial head, capitellum and coronoid process together in the same elbow. This is a case report highlighting this combination of fractures in a 30 year old patient treated with open reduction and internal fixation of all three fractures. The patient was followed up for 28 months and had a good range of motion of the elbow without any instability...
2015: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
Amir Samii, René Zellweger
The coronoid process of the ulna forms the anterior boundary of the trochlear notch and is crucial for elbow stability. Coronoid fractures are uncommon and they occur in aproximately 10% of elbow dislocations. They are mostly associated with ligamentous and capsular disruptions as well as concomitant fractures. Posterior elbow dislocations, combined with fractures of the coronoid and the radial head are known as the terrible-triad of the elbow. These injuries result in instability of the elbowjoint and, if not treated properly, lead to recurrent dislocations that can cause further damage...
April 2008: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Giuseppe Giannicola, Piergiorgio Calella, Andrea Piccioli, Marco Scacchi, Stefano Gumina
BACKGROUND: Terrible triad injury (TTI), one of the main patterns of complex elbow instability, is difficult to treat and yields conflicting surgical results. We analyzed prospectively a series of patient affected by TTI and treated according to the current diagnostic and surgical protocols to investigate whether their application allow to obtain more predictable outcomes. MATERIAL AND METHODS: We analyzed 26 patients with a mean age of 52 years. Preoperative X-rays and CT were performed; all patients were operated by the same elbow surgeon and underwent the same surgical and rehabilitation treatment...
December 2015: Injury
Guoqing Zha, Xiaofeng Niu, Weiguang Yu, Liangbao Xiao
Terrible triad of the elbow is characterized as posterior dislocation of the elbow joint accompanied by the fractures of the radial head and coronoid process of the ulna, which is rarely seen in clinical practice, especially because the mild fracture is barely detected by imaging method In this study, we reported one case of serious complex bilateral elbow injury, presenting with unilateral typical terrible triad of the elbow and suspected terrible triad of the elbow complicated with olecranon fracture on the other side...
2015: International Journal of Clinical and Experimental Medicine
Jérôme Pierrart, Thierry Bégué, Pierre Mansat
The terrible triad is an uncommon injury, which includes an elbow posterior dislocation with fractures of the radial head and coronoid process of the ulna. In addition there is rupture of the lateral and medial collateral ligaments. The short-term and long term results are historically poor, with a high rate of complications. The main objective of this study is to report the results of a multicentre study of patients who sustained the terrible triad injury focusing on surgical treatment in order to offer a standardized surgical protocol...
January 2015: Injury
Jian Xu, Shengxuan Sun, Cheng Li, Haibin Zhou, Qirong Dong
OBJECTIVE: To explore the effectiveness of non-absorbable suture or suture anchor fixation by anterior approach in the treatment of anteromedial facet fractures of the ulnar coronoid process. METHODS: Between February 2007 and February 2012, 16 cases of anteromedial facet fractures of the ulnar coronoid process were treated with operation. There were 9 males and 7 females, aged 20-80 years (mean, 43.5 years). The causes of injury were traffic accident injury in 7 cases, tumble injury in 5 cases, and falling injury from height in 4 cases...
July 2014: Chinese Journal of Reparative and Reconstructive Surgery
Neal C Chen, David Ring
The treatment of terrible triad injuries of the elbow continues to evolve. Radial head fixation and arthroplasty, coronoid process fixation, and repair of the lateral collateral ligament continue to be the mainstays of treatment. In the elbow with persistent instability after repair of these elements, application of a static external fixation, hinged external fixation, ulnohumeral joint pinning, or an internal hinge may be needed. In patients who undergo treatment after the acute injury period, the coronoid may require reconstruction using radial head autograft, iliac crest autograft, olecranon autograft, or allograft...
November 2015: Journal of Hand Surgery
Anderson de Aquino Santos, Thomaz Antônio Tonelli, Fabio Teruo Matsunaga, Marcelo Hide Matsumoto, Nicola Archetti Netto, Marcel Jun Sugawara Tamaoki
OBJECTIVE: To evaluate the results from surgical treatment of the terrible triad of the elbow, with a minimum of six months of follow-up, taking elbow function into consideration. METHODS: The analyzed aspects of 20 patients, who underwent surgical treatment of the terrible triad of the elbow, were given as follows: Dash score (Disabilities of the Arm, Shoulder and Hand), Meps (Mayo Elbow Performance Score), pain according to VAS (visual analog scale), ROM (range of motion), patient satisfaction, degree of energy of the trauma, complications and radiographs...
July 2015: Revista Brasileira de Ortopedia
Michael Hackl, Klaus Josef Burkhart, Kilian Wegmann, Boris Hollinger, Sven Lichtenberg, Lars Peter Müller
INTRODUCTION: Radiocapitellar arthroplasty represents a possible treatment option for isolated osteoarthritis of the radial column. We report the first case of early failure of this procedure. PRESENTATION OF CASE: We present the case of a 41-year old male who sustained a terrible triad injury to his right elbow and subsequently underwent radial head arthroplasty. Due to overstuffing of the radial head prosthesis, capitellar erosion occurred and radiocapitellar arthroplasty was thus performed...
2015: International Journal of Surgery Case Reports
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