MCL avulsion is likely to be present in many terrible triad injuries, and there is no consensus as to the need for a medial exposure in a terrible triad injury. Executive Editors. Epidemiology. The ‘terrible triad’ of the elbow is a severe injury that is difficult to treat and has a poor prognosis in the medium-to-long term. 2020 Jun 21;2020:6508781. doi: 10.1155/2020/6508781. Clin Orthop Relat Res . But if … 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. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. The mechanism of injury usually involves a fall with the arm in semiflexion, supination of the forearm and an elbow in a valgus position (1). With the numbers available, there was no difference in reoperation rate between groups (p = 0.45). The terrible triad of the elbow is characterized by great potential for joint instability and an unfavorable prognosis. Single-staged treatment using a standardized protocol results in functional motion in the majority of patients with a terrible triad elbow injury. NIH Most cases require surgery and a recovery period of six to nine months. Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome. Specifically, the question of whether to repair or replace the radial head remains controversial. 1 0 obj Level of evidence: Replacement or repair of terrible triad of the elbow: A systematic review and meta-analysis. terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation. An unhappy triad injury is one of the most severe sports injuries. Abstract.  |  eCollection 2019 Dec. Medicine (Baltimore). In this review, the classification, treatment principles and prognosis for different forms O'Donoghue estimated the incidence rate in the traumatic sports knee to be 25%. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach J Int Med Res . Terrible triad injuries account for approximately 30% of all elbow dislocations. Results: Swelling may be severe; Displaced equilateral triangle of olecranon and epicondyles (undisturbed in supracondylar fracture) Posterior dislocation. Retrospective review identified 39 patients with terrible triad injuries and minimum 18-month complete clinical and radiographic followup (mean, 24 months; range, 18-53 months). Epub 2015 Oct 1. This site needs JavaScript to work properly. The 'terrible triad of the elbow' refers to a combination of elbow dislocation and radial head and coronoid process fracture - it is notoriously difficult to manage although a systematic review found that whilst complications are common, functional outcomes are generally satisfactory . Gupta A, Barei D, Khwaja A, Beingessner D. Clin Orthop Relat Res. Please enable it to take advantage of the complete set of features! There were no differences between groups in terms of ROM or elbow scores. Whereas the importance of early recognition of neurovascular compromise is well described and nearly universally recognized, the importance of timely and correct treatment in preventing delayed complications and potential instability is often less emphasized in the radiology literature. 472 (7):2128-35. . COVID-19 is an emerging, rapidly evolving situation. Specifically, the question of whether to repair or replace the radial head remains controversial. The terrible triad of the elbow is characterized by great potential for joint instability and an unfavorable prognosis.1, 5Surgical treatment is the therapy of choice in the vast majority of cases, with the aims of restoration of the anatomy and early mobility. Maintenance of concentric reduction on a lateral fluoroscopic view indicates stability. 2014 Jul;472(7):2084-91. doi: 10.1007/s11999-014-3471-7. [Progress in treatment of terrible triad of elbow]. Elbow held in 45 degree of flexion; Olecranon is prominent posteriorly 2014 Jul. A bump is placed under the humerus with the elbow extended and forearm supinated. The elbow is prone to stiffness, as such operative stabilization of complex injuries is imperative to allow for early mobilization. Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. Conclusions: Open reduction and internal fixation of radial head fractures: do outcomes differ between simple and complex injuries? Authors of section Editors. The terrible triad primarily occurs in adults; the flexibility of ligaments in children … 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. Prediction and Potential Preventions for the Development of Posttraumatic Osteoarthritis after the Terrible Triad Injury: A Multicenter Risk Factors Study. 27 patients from Beijing, China, with the terrible triad of the elbow were retrospectively evaluated. J Hand Surg Am. Methods: 1,2 The injury consists of a 336 R Seijas et al. Relatively few studies have documented the outcomes of terrible triad injuries of the elbow. For terrible triad injuries, radial head arthroplasty afforded the ability to obtain elbow stability with comparable overall outcomes when compared to ORIF. BACKGROUND: The terrible triad of the elbow comprises an ulnar coronoid process fracture, a radial head (RH) fracture and posterior dislocation of the elbow. eCollection 2020. Choose treatment. A diagram outlines the treatment algorithm used for radial head management in the…, A photograph demonstrates the hanging arm test. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. In the mornings when I stretch, I do feel it stretching out, which is kind of satisfying, as the terrible triad … 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. Main indications. As these injuries commonly occur in younger patients, longer-term studies will be required to ascertain whether the apparent benefits of radial head arthroplasty are offset by late complications of arthroplasty, such as loosening. Although terrible triad injuries have been traditionally described as having a poor long-term prognosis, good and excellent results have been achieved with increased understanding of elbow … eCollection 2020 Jul. Evaluation included the DASH score, the Broberg-Morrey index, measurements of elbow stability and motion, and radiographic assessment for signs of arthrosis; chart review was performed for complications and reoperations. Background: 2014 Jul;472(7):2075-83. doi: 10.1007/s11999-014-3475-3. A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. Given the poor prognosis for such injuries, they have been given the name of the "terrible triad of the elbow". A diagram outlines the treatment algorithm used for radial head management in the treatment of terrible triad injuries, along with intraoperative assessment of stability with the hanging arm test. In the realm of orthopaedics, the terrible triad of the elbow is infamous, not simply because the prognosis is poor for most patients, but also, maybe to a greater extent, because the unique name of this malady attracts considerable attention and interest in both doctors and patients. <>stream [ 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. 2014; 472(7):2128-35 (ISSN: 1528-1132) Watters TS ANYWAY, my elbow is 100% healed…it hasn’t caused me any inconvenience or pain in the longest time. Dislocation with Articular Fracture . A bump is placed under the…, ( A ) AP and ( B ) lateral radiographs show a 22…, NLM )�|�j���Ә�7��{���Gdn��{��i�U�m.��0.Wl���?d�?��!jʺ=`ï@�p��7���ۏ~R��d5��"��Q�d j Z�\Ҡ?�/j�'>7` Li J, Lu D, Lin W, Li Q, Hu J, Xu D, Zhao Y, Guo W. Biomed Res Int. 2014 Jul. Clin Orthop Relat Res. 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. 2013. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. �),�@�3���`�b�Є%�����P�qd�C�7. Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis?. Diagnosis. Clin Orthop Relat Res. Background: Surgical treatment for terrible triad injuries of the elbow (defined as elbow dislocations with concomitant fractures of the radial head and coronoid) remains a challenging clinical problem. The terrible triad of the elbow is characterized by great potential for joint instability and an unfavorable prognosis.1, 5Surgical treatment is the therapy of choice in the vast majority of cases, with the aims of restoration of the anatomy and early mobility. Anterior . Clin Orthop Relat Res. Posterior elbow dislocation with fracture of the coronoid process and radial head fracture. Why does radial head arthroplasty fail today? The weight of the hand and forearm acts as a dislocating force in this position of maximal instability. Peter Kloen, David Ring. Equipment. Eleven patients (28%) underwent reoperation (seven arthroplasty, four ORIF) for various reasons. 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. were the first to introduce it to China in 2005 6. A delay in treatment or revision surgery resulted in a 20% greater loss of … 2015 Nov;40(11):2297-303. doi: 10.1016/j.jhsa.2015.04.039. <>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/TrimBox[0 0 595.27600 841.89001]>> A study was conducted to evaluate the diagnosis and surgical treatment of the terrible triad of the elbow. 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. Posterior . Orthopedics | Terrible triad elbow injuries, consisting of fractures of the radial head and coronoid with ulnohumeral dislocation, are challenging to treat. See this image and copyright information in PMC. 2018 Aug;46(8):3053-3064. doi: 10.1177/0300060518771263. Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis?. It is a complex trauma, associating … %PDF-1.6 %���� Dislocation + radial head fracture . Capitellum fractures are uncommon, but their prompt diagnosis and management are crucial due to the severity of the consequent functional impairment resulting from these intra-articular elbow fractures. The terrible triad injury of the elbow, dislocation of the ulnohumeral joint with fractures of the coronoid process and radial head, is difficult to treat and has a historically poor outcome. Pugh and McKee 27 reported a mean arc of flexion of between 20° and 135° and mean rotation of 135°. Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). Questions/purposes: terrible triad of the elbow.6,7 Its prognosis remains uncertain, especially over the long term.6 The objective of the present study was to evaluate the results from surgical treatment of the terrible triad of the elbow, with at least six the S��0�B��{�^����vfB�!D'���r-I�lN���^�3>xDN����rzV�C��[SUx�k��jo�)GR�-wJt��i����U�&&���a_��v��X�wT�5��X=� :�p�o:Lî�7e�#$}p�)������Jy�����8Ng�nL��mm�j41> Q�� a���XS�0�B�=���OEFgW��?h�p��Z=�4%���a��MZ��1��~�;!�}{��P,��c��F�����t`�V�gQ��~����8��rB��ڋL@@�h ��1�~�W��-U-Nhm��1�G�(ʮ��y;] �K�Wɖ? If the elbow dislocates in 30°–45° of extension, the medial collateral ligament should be repaired. View This Abstract Online Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis? Dr reports a "Terrible Triad Injury" which is, per the Op Note, Radial head fx, coroniodprocess avulsion fx and collateral ligament disruption. The terrible triad of the elbow remains a challenging injury that consists of a dislocation of the elbow with fractures of the radial head and coronoid process of the ulna. Patterns of Traumatic Elbow Instability With Fracture . Specifically, the question of whether to repair or replace the radial head remains controversial. Terrible triad. Some of the most common injury classification systems cited in … doi: 10.1097/MD.0000000000013054. Surgical treatment for terrible triad injuries of the elbow (defined as elbow dislocations with concomitant fractures of the radial head and coronoid) remains a challenging clinical problem. 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). BACKGROUND: The terrible triad of the elbow comprises an ulnar coronoid process fracture, a radial head (RH) fracture and posterior dislocation of the elbow. With the improvement of knowledge on elbow biomechanics and pathoanatomy, the current standard strategy appeared to have yielded more favorable outcomes [ 2 , 3 ]. Open all credits. 3 0 obj Because case series are relatively small, it is difficult to estimate the incidence of complications. 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/. This objective remains a challenge for surgeons due to the complexity of the lesion.5 Dislocation Injuries Disruption Injuries Fracture of the anteromedial facet of the coronoid process with injuries to the anterior and posterior bundles of the ulnar collateral ligament and to the lateral ligaments, consistent with varus posteromedial rotatory instability of the elbow (PMRI). A photograph demonstrates the hanging arm test. 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