Results of terrible triads in the elbow: the advantage of primary restoration of medial structure

Jeong, Woong Kyo; Oh, Jong Keon; Hwang, Jin Ho; Hwang, Seok Min; Lee, Won Seok

doi:10.1007/s00776-010-1515-8

Cited by 57 publications

(45 citation statements)

References 25 publications

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“…This result is consistent with findings of a previous study showing that the lateral approach or medial window provide with a much wider surgical space for the coronoid fractures, even without damaged MCLs, and common flexor masses can be easily repaired [20]. This is reasonable since combined lateral and medial approach involves a much more complicated surgical process.…”

Section: Discussionsupporting

confidence: 92%

“…It has been reported that repair of the MCL is of great importance in treatment of elbow fracture-dislocation and MCL may play an import role in valgus stability of the elbow [5]. A previous study showed that restoration of the damaged structures, including medial soft tissue structures, indicates excellent results based on MEPS in patients with TTE [20]. In TTE, the lateral collateral ligament, MCL, and anterior capsule are usually torn and soft tissues were injured, all of which are important determinants of elbow stability [21].…”

Section: Discussionmentioning

confidence: 99%

“…During the TTE operation, lateral approaches are useful in addressing pathology at the radial head, coronoid process, and anterior and posterior capsules, while medial approach is effective in addressing ulnar nerve, the anterior and posterior capsules, and the coronoid process [23]. Although the combined lateral and medial approach may be associated with longer recovery time, this approach was able to restore anterior and lateral lesions, as well as medial lesion in TTE tissue, and use of the lateral approach may not be able to remove all the small bone fragments [20]. …”

Section: Discussionmentioning

confidence: 99%

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Surgical Outcomes and Complications in Treatment of Terrible Triad of the Elbow: Comparisons of 3 Surgical Approaches

Chen

2016

Med Sci Monit

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BackgroundThis study compared the efficacy of combined lateral and medial approach, lateral approach, and anterior medial approach in treatment of terrible triad of the elbow (TTE).Material/MethodsThirty-eight TTE patients hospitalized in our center were retrospectively analyzed, among which 14 patients were arranged for combined lateral and medial approach, 12 for lateral approach, and 12 for anterior medial approach. All included patients underwent open reduction, collateral ligament repair, and postoperative function exercise. Follow-up was conducted for 13~22 months. The elbow motion, excellent and good rate, healing time, and complication rate were recorded and compared.ResultsThese 3 approaches significantly improved the postoperative elbow motion, MEPS, VAS, excellent and good rate, and open reduction (all P<0.05). The VAS score for lateral approach was evidently higher than that for combined lateral and medial approach (P<0.05). Combined lateral and medial approach and anterior medial approach had better performance on elbow motion, MEPS, and excellent and good rate than lateral approach (both P<0.05). Lateral approach and anterior medial approach had a significantly reduced healing time compared with combined lateral and medial approach (both P<0.05), while anterior medial approach had a higher complication rate compared with anterior medial approach and lateral approach (both P<0.05).ConclusionsLateral combined medial surgery approach contributes to wide surgical exposure, facture stability, and decreased complication rate, and thus has superior efficacy than the other 2 surgical approaches.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical Outcomes and Complications in Treatment of Terrible Triad of the Elbow: Comparisons of 3 Surgical Approaches

Chen

2016

Med Sci Monit

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“…Two studies [21], [23] reported that mean scores excellent, whereas mean scores in the remainder of the studies were good. Overall, for the studies reporting individual patient results (N = 155 patients), 61 (39%) patients had excellent scores, 66 (43%) had good scores, 23 (15%) had fair scores, and 5 (3%) had poor scores.…”

Section: Resultsmentioning

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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“…Tears of the MCL can be treated surgically by direct suturing or by reattachment [18][19][20]. Ashwood et al believe that swift repair of the MCL allows early mobilization of the injured elbow [19].…”

Section: Introductionmentioning

confidence: 99%

Medial collateral ligament healing after posttraumatic radial head arthroplasty: A retrospective study of 33 cases with a mean follow-up of 73 months

Wapler

Fontaine

Mesnil

et al. 2016

Hand Surgery and Rehabilitation

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Results of terrible triads in the elbow: the advantage of primary restoration of medial structure

Cited by 57 publications

References 25 publications

Surgical Outcomes and Complications in Treatment of Terrible Triad of the Elbow: Comparisons of 3 Surgical Approaches

Surgical Outcomes and Complications in Treatment of Terrible Triad of the Elbow: Comparisons of 3 Surgical Approaches

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

Medial collateral ligament healing after posttraumatic radial head arthroplasty: A retrospective study of 33 cases with a mean follow-up of 73 months

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