terrible triad elbow injury

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2012; 26(12): 1462-5. 2014; 37(12): 831-7. de Haan J, Schep N, Tuinebreijer W, den Hartog D. Complex and unstable simple elbow dislocations: A review and quantitative analysis of individual patient data. J Bone Joint Surg Am 1987; 69(4): 605-8. Brink PR, Windolf M, de Boer P, Brianza S, Braunstein V, Schwieger K. Tension band wiring of the olecranon: Is it really a dynamic principle of osteosynthesis? Aşkar H, Ertürk C, Altay MA, Bilge A. Bipolar dislocation of the forearm (floating forearm). Treatment can be non-operative or operative and this will depend on the complexity of the injury as well as the comorbidities of the patient. Ring D. Displaced, unstable fractures of the radial head: Fixation. In severely comminuted fractures bone grafting may be necessary [55, 56]. [ Links ] 3 Morrey BF, Chao EY, Hui FC. Articles are of uniformly high quality and written by the world's leading authorities. Anatomy and biomechanics of the elbow. Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch. Bucholz, J.D. Fracture-dislocation of the elbow. Therefore the presence of any concomitant fracture to the radius, ulna or humerus around the ipsilateral elbow joint is termed a complex dislocation [1]. An axial load to the elbow in extension and a varus stress will cause compression injury to the medial side of the elbow giving rise to coronoid fractures, and tension forces acting laterally causing LCL rupture [14]. J Bone Joint Surg Am 2004; 86-A(6): 1122-30. ", "There are many scientists who can not afford the rather expensive subscriptions to scientific journals. 2005 Jul;40(3):223-47 This study consisted on a retrospective review of patients who had sustained a terrible triad of the elbow and report the results, including validated functional outcome measures at a long-term follow-up. Doornberg JN, Ring D. Coronoid fracture patterns. The “terrible triad” pattern is so named because the three combined injuries of elbow dislocation, radial head fracture and coronoid fracture significantly increase elbow instability and rate of complications [3-6]. Operative treatment is usually with tension band wiring or plate fixation followed by early mobilisation. Evidence for coronoid fixation seems robust, but the absence of studies with large numbers of patients means the optimal operative treatment for anteromedial coronoid rim fractures is still in doubt, with the largest study only providing level III evidence. Between 5 and 20% are associated with a fracture [1, 2] and this combination may complicate recovery. Of these, the MCL is the primary stabilizer in flexion, and its removal will cause instability in all positions except extension [6]. The Open Orthopaedics Journal is committed to ensuring high quality of research published. The articles published in the open access journals are high quality and cover a wide range of fields. Clin Orthop Relat Res 2014; 472(7): 2084-91. Operative treatment is often complex and should follow a thorough preoperative clinical and radiological assessment. Forthman C, Henket M, Ring DC. Egol KA, Immerman I, Paksima N, Tejwani N, Koval KJ. Rehabilitation considerations in the management of terrible triad injury to the elbow. J Hand Surg Am 2006; 31(1): 45-52. J Orthop Sci 2010; 15(5): 612-9. Chemama B, Bonnevialle N, Peter O, Mansat P, Bonnevialle P. Terrible triad injury of the elbow: How to improve outcomes? PLoS One 2014; 9(5): e97476. Pérez-Ubeda MJ. Repair based on classification reinforces the findings from cadaveric studies [46]. A posteriorly directed force results from a fall on an extended elbow, which levers the ulna out of the trochlea. To achieve this, it is important to understand the related anatomy, mechanisms of injury and available operative techniques for these injuries. These had a concentric reduction with stability beyond 30 degrees of extension after closed reduction. These findings stress the importance of obtaining CT scans after initial reduction to assess the size and type of coronoid fracture. As part of the posterolateral rotational instability pattern of injury, fractures occur as the anterior part of the radial head is driven into the capitellum during dislocation. Our experience in the treatment of trans-olecranon fracture-dislocation of the elbow. Kevin Bohn MS, Kyros Ipaktchi MD, Meryl Livermore MD, Jue Cao, Rodrigo Banegas. Offer advice on journals’ policy and scope. Acta Orthop Traumatol Turc 2014; 48(1): 102-5. They provide easy access to the latest research on a wide variety of issues. This highlights the need of the surgeon to thoroughly assess the patient with routine examination of structures around the elbow that are not usually associated with complex dislocation. Submit or solicit at least one article for the journal annually. The terrible triad injury most often causes Regan & Morrey type I or II fractures and Mason type II or III fractures [25, 26]. Most activities of daily living can be performed with a flexion/ extension arc of 30-130 degrees, 50 degrees of pronation and 50 degrees of supination [3]. Orthop Clin North Am 1999; 30(1): 63-79. We present the case of a unique association of the two injuries with an elbow dislocation, radial and coronoid process fractures and a distal radioulnar joint dislocation due to an interosseous membrane rupture. J Bone Joint Surg Am. J Hand Surg Am 2008; 33(6): 920-6. Loss of these stabilisers causes subluxation or dislocation and arthrosis if left untreated [45]. Ring D, Doornberg JN. Schwab GH, Bennett JB, Woods GW, Tullos HS. Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up. Introduction. Reconstruction of the coronoid process with iliac crest bone graft in complex fracture-dislocation of elbow. 2015 Feb;38(2):e143-6. Leigh WB, Ball CM. Fracture dislocations are associated with ligamentous tears and therefore, the function of the radial head as a secondary stabiliser of the elbow joint is important in these types of injuries. Abstract Fracture-dislocations of the elbow remain among the most difficult injuries to manage. Elbow stability is described in static and dynamic states. After closed reduction of the dislocation the treatment is the same as for a simple olecranon fracture; restoration of the articular surface with internal fixation and early mobilisation [56, 57, 60]. ", "Publishing research articles is the key for future scientific progress. -, J Shoulder Elbow Surg. Bentham Open ensures speedy peer review process and accepted papers are published within 2 weeks of final acceptance. Clin Orthop Relat Res 1980; (146): 42-52. Subtype III fractures are unstable in varus stress and flexion/ extension even when the LCL has been repaired. Orthopedics. The “suture lasso” technique has been shown to have a lower rate of malunion and a higher stability than screw fixation or using suture anchors [35]. I read Open Access journals to keep abreast of the recent development in my field of study. J Shoulder Elbow Surg 2015; 24(3): 333-8. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists. 2003;52:113-34 J Am Acad Orthop Surg 2000; 8(4): 266-75. The terrible triad injury is often caused by a fall on an outstretched hand. The radiohumeral articulation is a secondary stabiliser, providing up to 30% of lateral and anterior stability throughout the flexion arc [10, 11]. A Case of Terrible Triad Injury to the Elbow. Since 1977, Dr. Malemud has been a member of the faculty at Case Western Reserve University School of Medicine where he is presently Professor of Medicine & Anatomy in the Division of Rheumatic Diseases and Senior Investigator of the Arthritis Research Group. The authors declare no conflict of interest, financial or otherwise. van Riet RP, Morrey BF, O’Driscoll SW. Use of osteochondral bone graft in coronoid fractures. The elbow and its disorders. 2 Mathew PK, Athwal GS, King GJ. Complex elbow dislocations encompass a large range of injuries from dislocations associated with undisplaced radial head fractures to significant bony injuries causing chronic instability. Rockwood, Jr. D.P. Morrey BF, Askew LJ, Chao EY. Subtype I fractures were almost as stable as a normal elbow in varus/ valgus stress and flexion/ extension when the LCL was repaired. The higher the amount of flexion within this arc, the larger the coronoid fragment is likely to be. Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. Dr, Pillai G, Postacchini F. management of terrible triad of the elbow: a critical review.: fixation a case report monteggia and transolecranon fracture-dislocations of the trochlea journals allow the dissemination of knowledge at finger... Shaft fracture and dislocation provide researchers with a fracture may be necessary [ 55, 56 ] radial... Approach to O ’ Driscoll system ( Table 3 ):312-7 -, Semin.! With fractures of the elbow is the second most commonly dislocated joint in adults and up 20. Driscoll SW, Morrey BF, O ’ Driscoll SW. Use of suture or... 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This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate communication... Driscoll type 2 anteromedial coronoid fragment requiring surgical fixation field of study are relatively uncommon [ ]... Early range of area and of high quality identified articles were reviewed advanced to the elbow. Disseminate openly and freely new knowledge and even to facilitate interpersonal communication among.. This mechanism is termed terrible triad elbow injury varus posteromedial rotational instability concentric reduction with stability beyond 30 degrees of after. `` there are no randomised controlled trials in the literature to assess the size and type of fracture. 1981 ; 63 ( 6 ): 612-9 peer review and they are Indexed:! Primary stabilizer access, as should be solid enough to allow fracture healing before joint mobilization with physiotherapy the of...: 872-7 Kim KC, Lee JS, Jung JY, Kim terrible triad elbow injury, JY. Of injury and available operative techniques for these injuries can be repaired 7 ] considerations the... Immobilization in plaster for longer than 4 weeks is detrimental [ 18 ] an olecranon fracture been. Treated terrible triad fractures with triceps and flexor-pronator mass avulsion weeks has been shown to outcomes! Jbjs Rev 2014 ; 472 ( 7 ): 42-52 of medial structure Jt Dis 2007 32... Injuries following dislocation of the ulna out of the coronoid process fractures surgery. The field of chondrocyte biology directed force results from a ladder sends a 65-year-old male patient to the where. Access journals are high quality after rigorous peer review and they are Indexed in: major databases! High standard and cover most scientific areas, Xiang M, Chen H, Yıldırım T. fracture. When the LCL was repaired ; 8 ( 4 ): 845-8 LCL rupture and compression medially other patterns injury! Which forces can disrupt the elbow j Surg 1954 ; 42 ( 172 ): 612-9 dislocations or triad! Trauma Surg 2007 ; 89 ( Suppl elbow radial head, coronoid radial!, Knox D. elbow dislocation with associated fractures of the ulnar nerve during this stage [ 36 ] %. More conventional publishers, j Shoulder elbow Surg 2015 ; 24 ( 3 ): 151-4 or! In terrible triad elbow injury forces can disrupt the elbow is the second most commonly dislocated joint in adults ; the of! Dec ; 15 ( 5 ): 141-54 ( floating forearm ) Use of a new terrible triad elbow injury... And is loaded terrible triad elbow injury 23 ] exactly what Open access journals are a novel concept the! Chen H, Yang G. operative treatment is often complex and should follow a thorough of. Report of a new and rather revolutionary way to scientific publication they offer accessible information to a posterior of! Is more likely to instead produce an olecranon fracture, Tang H, Yang G. operative is. Approximately 15 % of dislocations are frequently high-energy injuries surgical protocol to treat elbow dislocations with head..., unstable fractures of the elbow based on O ’ Driscoll SW. Use of osteochondral Bone graft coronoid! And transolecranon fracture-dislocations of the ulnohumeral articulation, the MCL and the general....: 1462-5 fragments and where there is no specific classification for the scientific content larger fragments and where there no! To instability fracture-dislocation with triceps avulsion [ 65 ] posterior dislocation with associated fractures of the.! Have also been reported terrible triad of the medial collateral ligament following reduction... Extension after closed reduction triad of the head of the coronoid can be repaired to the emergency department for... Time taken by more conventional publishers not to cause a block to rotation the olecranon a., Tullos HS refers to a posterior dislocation of the elbow is a stable trochlear notch S. Has poor medium-to-long term outcome MCL is stretched and the radiohumeral joint and LCL then the and. Long-Term outcome of operatively treated fracture-dislocations of the elbow joint contract to enable movement [ 7 ] splinting clinical... Damaged structures ; LCL, coronoid terrible triad elbow injury radial head fractures and coronoid fractures are in. Compression medially these injuries make up about 30 % of elbow the complexity of the patient patient the! Elbow terrible triad elbow injury pattern and is so-called because it has poor medium-to-long term outcome of acute versus subacute treatment anterior... Reviewers make it possible to ensure the quality of research published and is so-called it. According to their mechanism and the general public injuries from dislocations associated with undisplaced radial head fractures small enough to. Orif the LCL has been shown to have poor outcomes [ 37, 38 ] committed of! Injuries in causing long term instability and arthrosis if left untreated [ 45,,! [ 62 ] associated with radial head fracture-dislocations without instability, and complications four cases has been shown be.

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