Rehabilitation Considerations in the Management of Terrible Triad Injury to the Elbow

Pipicelli, Joey G.; Chinchalkar, Shrikant J.; Grewal, Ruby; Athwal, George S.

doi:10.1097/bth.0b013e31822911fd

Cited by 22 publications

(8 citation statements)

References 30 publications

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“…The aim of surgery in managing TTIE is the restoration of stability of the humeroulnar and humeroradial joints, thus facilitating early postoperative elbow motion to reduce the likelihood of long-term joint stiffness or disability [3], [5]. Clearly, to optimize the chances of success, such surgery must adequately account for all three injury components of the terrible triad [3].…”

Section: Introductionmentioning

confidence: 99%

Complications of Treating Terrible Triad Injury of the Elbow: A Systematic Review

Chen¹,

Liu

2014

PLoS ONE

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ObjectiveTerrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications following surgical management of TTIE.MethodsMedline, EMBASE, Cochrane Library, and Google Scholar were searched to identify relevant studies, which were included if they were retrospective or prospective in design, involved participants who had TTIE, and were published in English. Outcomes of interest were functional outcomes and complications.ResultsSixteen studies, involving 312 patients, were included in the systematic review. Mean follow up after surgery was typically 25 to 30 months. Mean Mayo elbow performance scores ranged from 78 to 95. Mean Broberg-Morrey scores ranged from 76 to 90. Mean DASH scores ranged from 9 to 31. The proportion of patients who required reoperation due to complications ranged from 0 to 54.5% (overall = 70/312 [22.4%]). Most of these complications were related to hardware fixation problems, joint stiffness, joint instability, and ulnar neuropathy. The most common complications that did not require reoperation were heterotopic ossification (39/312 [12.5%] patients) and arthrosis (35/312 [11.2%] patients).ConclusionsThe results of this systematic review indicate that functional outcomes after surgery for TTIE are generally satisfactory and that complications are common. Further research is warranted to determine which surgical techniques optimize functional outcomes and reduce the risk of complications.

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Section: Introductionmentioning

confidence: 99%

Complications of Treating Terrible Triad Injury of the Elbow: A Systematic Review

Chen¹,

Liu

2014

PLoS ONE

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“…We also acknowledge that there may be substantial variation among different orthopaedic surgeons and institutions in terms of their approaches to the nonsurgical management of patients with these injuries, and the results we achieved with our protocol may not generalize to all approaches to the nonoperative management of the terrible triad injury. However, a standardized treatment protocol currently does not exist in the literature and the evidence on the rehabilitation after such injuries is limited [12]. Finally, it is worth emphasizing that our patients were carefully selected and likely represented a very small percentage of the overall number of patients treated for terrible triad injuries [10].…”

Section: Discussionmentioning

confidence: 99%

“…Early active and active-assisted elbow flexion/extension exercises with the forearm in neutral rotation and forearm rotation exercises with the elbow at 90°of flexion were initiated. Supine positioning with overhead exercises may facilitate early effective ROM [12]. The optimal amount of therapy is unknown, but we typically recommended 10 to 15 repetitions every 2 to 3 hours as tolerated [12].…”

Section: Description Of Treatmentmentioning

confidence: 99%

“…Supine positioning with overhead exercises may facilitate early effective ROM [12]. The optimal amount of therapy is unknown, but we typically recommended 10 to 15 repetitions every 2 to 3 hours as tolerated [12]. Posterior elbow resting splints with the elbow maintained at 80°to 90°of flexion and neutral forearm rotation were employed for up to 6 weeks.…”

Section: Description Of Treatmentmentioning

confidence: 99%

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Can We Treat Select Terrible Triad Injuries Nonoperatively?

Chan

MacDermid

Faber

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…The goal in treating these injuries is to restore early elbow stability to avoid complications such as loss of function and joint stiffness. 1 , 2 Over time, surgery has been shown to be the best option for obtaining satisfactory functional results. 3 The literature shows differences between the surgical techniques used with regard to access routes and the approach to the affected bone structures and ligaments.…”

Section: Introductionmentioning

confidence: 99%

Terrible Triad of the Elbow: Functional Results of Surgical Treatment

Ikemoto¹,

Murachovsky

Bueno

et al. 2017

Acta ortop. bras.

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Objective:To evaluate the functional and radiographic results of patients who underwent surgical treatment for terrible triad-type elbow injuries (TTE). Methods:We retrospectively evaluated 20 patients, including one case with bilateral injuries (total of 21 elbows) that were surgically treated from January 2004 to July 2014. We evaluated the functional results of treatment by measuring the restored range of motion (ROM) of the elbow, using the DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. Complications and the development of osteoarthritis and heterotopic ossification (HO) were also evaluated. Results:Eight elbows (38%) required additional surgical treatment; HO was observed in eight elbows (38%) and severe osteoarthritis (Broberg-Morrey type IV) was seen in only one case (4%). Nevertheless, we obtained good functional results, 14.27 on the DASH and 84 on the MEPS. The average ROM for flexion-extension was 101° (20-140°) and for pronation-supination was 112.85° (0-180°). Conclusion:When TTE injuries are treated systematically, even despite variations in these injuries, functional ROM and scores ranging from good to excellent can be obtained. Level of Evidence IV, Case Series.

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Rehabilitation Considerations in the Management of Terrible Triad Injury to the Elbow

Cited by 22 publications

References 30 publications

Complications of Treating Terrible Triad Injury of the Elbow: A Systematic Review

Complications of Treating Terrible Triad Injury of the Elbow: A Systematic Review

Can We Treat Select Terrible Triad Injuries Nonoperatively?

Terrible Triad of the Elbow: Functional Results of Surgical Treatment

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