Case Series of All-Arthroscopic Treatment for Terrible Triad of the Elbow: Indications and Clinical Outcomes

Lee, Sung Hyun; Lim, Kyeong Hoon; Kim, Jeong Woo

doi:10.1016/j.arthro.2019.09.014

Cited by 15 publications

(6 citation statements)

References 33 publications

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“…Although surgical treatment is effective for the vast majority of patients medically suitable for operation, the high incidence of complication should not be neglected [16][17][18][19]. With the increasing knowledge of elbow mechanism and pathology of terrible triad injury, many studies have presented good radiological and clinical results [7,9,20]. Unfortunately, elbow stiffness is still a common complication, which severely decreases the patients' quality of life [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

What Factors Are Associated With Elbow Stiffness After Operation of Terrible Triad Injury？

Zhu

Deng

Cheng

et al. 2021

Preprint

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Background: The elbow stiffness is a common complication after operation of terrible triad injury (TTI) and significantly impair the patients’ activities of daily living, while the risk factors have yet to be clearly identified. The goal of this study was to examine the patient-related, injury-related, and treatment-related factors for elbow stiffness after operation of terrible triad injury.Methods: Between January 2013 and December 2019, 71 patients at two tertiary-care referral centers underwent operation of terrible triad injury were respectively reviewed. Range of motion (ROM), Mayo elbow performance scores (MEPS), Broberg-Morrey scores were used for functional evaluation. According to the ROM, the patients were categorized into stiffness group and non-stiffness group. The former had < 100° of extension-flexion ROM and the latter had > 100°. The patient-related, injury-related, and treatment-related factors were extracted from the medial records. The multivariant logistic regression were performed to identify the independent factors.Result: At a mean follow-up of 35.9 months (12-68 months),13 patients were classified into the stiffness group and 58 patients in the non-stiffness group. The stiffness group had significant worse functional scores compared to the non-stiffness group. Patients in the stiffness group were more likely to be Mason type III fracture, high-energy injuries, to have longer time between injury and surgery, ipsilateral upper limb injuries, and other fractures in body. However, multivariant logistic regression analysis revealed that time between injury and surgery > seven days, concurrent ipsilateral upper limb injuries and high-energy injury were independent factors that increased the risk of elbow stiffness after operation of terrible triad injury.Conclusions: The patients underwent operation for terrible triad injury should be informed the probability of elbow stiffness when concurred ipsilateral upper limb injuries and operations should be conducted without delay. Knowledge of these risk factors will be helpful for guiding prophylaxis and early intervention in patients with high risk of elbow stiffness after operation of terrible triad injury.

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Section: Discussionmentioning

confidence: 99%

What Factors Are Associated With Elbow Stiffness After Operation of Terrible Triad Injury？

Zhu

Deng

Cheng

et al. 2021

Preprint

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“…Lee et al reported a series of terrible triad injuries that were treated entirely arthroscopically. [72] The coronoid was fixed in all patients with Kirschner wires or pull-out sutures. About 17% had radial head fractures treated with screws or Kirschner wires and 46% had a fragment excised.…”

Section: Coronoidmentioning

confidence: 99%

“…[101] The LUCL can also be repaired as part of terrible triad injuries and posteromedial rotatory instability injuries. [70,72,102] Arthroscopy is also of value in assessing chronic instability such as posterolateral rotatory instability (PLRI). In lower grade PLRI, LUCL plication has had promising results.…”

Section: Tennis Elbow (Lateral Epicondylitis)mentioning

confidence: 99%

Advances and future trends in elbow arthroscopy

Robinson¹

2020

JASSM

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Elbow arthroscopy has evolved since its inception and is now a commonly used technique in the diagnosis and treatment of elbow pathology. It has many indications, from the removal of intra-articular loose bodies to the management of elbow osteoarthritis and fractures. In this paper, we will discuss the full spectrum of elbow arthroscopy covering recent evidence, surgical techniques, advances, and future trends.

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“…I read with great interest the article "Case Series of All-Arthroscopic Treatments for Terrible Triad of the Elbow: Indications and Clinical Outcome" by Lee, Lim, and Kim. 1 They describe their excellent results of an allarthroscopic treatment in quite a large group of patients with a specific pathology. I liked their arthroscopic stepby-step approach to treat this difficult pathology.…”

Section: See Related Article On Page 431mentioning

confidence: 99%

“…Another observation is the fact that Lee et al 1 described reducibility as an indication for operative treatment of radial head fractures but they did not describe a clinical assessment of a mechanical block to rotation. 4 In my opinion, evaluation of a mechanical block is an important step to obtain a treatment plan.…”

Section: See Related Article On Page 431mentioning

confidence: 99%

Editorial Commentary: Do We Need to Treat All Lesions Operatively in Elbow Terrible Triad?

Tongel

2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Arthroscopic reduction and fixation techniques in elbow surgery are evolving, and more and more literature is describing good outcomes of new arthroscopic fixation methods for coronoid fractures, lateral collateral ligament tears, radial head fractures, or capsular avulsions. The possible next step could be to use all these different techniques in cases in which all the described lesions can be seen. However, the question is if this approach is too aggressive. Although it is technically feasible to perform, this approach may not be necessary.

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Case Series of All-Arthroscopic Treatment for Terrible Triad of the Elbow: Indications and Clinical Outcomes

Cited by 15 publications

References 33 publications

What Factors Are Associated With Elbow Stiffness After Operation of Terrible Triad Injury？

What Factors Are Associated With Elbow Stiffness After Operation of Terrible Triad Injury？

Advances and future trends in elbow arthroscopy

Editorial Commentary: Do We Need to Treat All Lesions Operatively in Elbow Terrible Triad?

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