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

Abstract

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.

Lateral Approach Versus Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis

“…This is expected since combined approach led to more extensive dissection as compared to lateral approach and is much more complicated surgical procedure. Chen demonstrated an increased healing time with combined approach when compared to lateral approach [6]. The increased healing time in turn may lead to delayed recovery.…”

“…However, there is still no consensus on the better approach. Chen et al, [6] demonstrated that combined approach leads to extended surgical exposure, fracture stability and reduced complication rate compared to lateral approach. To facilitate a clinical decision, we conducted a meta-analysis comparing lateral approach and combined approach for terrible triad of elbow We found that the elbow range of motion, pronationsupination and MEPS were significantly more in the combined approach.…”

“…Clearly, to optimize the chances of success, such surgery must adequately account for all three injury components of the terrible triad [3]. A number of studies comparing lateral approach (LA) with combined mediolateral approach (CML) have been conducted [6][7][8][9]. However, these studies were limited in sample size and quality of methodology, and failed to draw a definitive conclusion on which operative approach is optimal for terrible triad of elbow in reducing complications and improving prognosis.…”

Single Modified Posterior Approach through the Space of the Proximal Radioulnar Joint for Terrible Triad Injury: A Comparative Study

“…The conventional posterior trans‐olecranon approach requires an extended posterior incision, extensive free medial and lateral skin flaps, and removal of the olecranon, which may result in serious damage to the soft tissue, a compromised blood supply, new fractures, and elbow stiffness. Researchers have noted that the CLMA achieves a better therapeutic effect than the single lateral approach or single anteromedial approach for TTI 14 . The CLMA may be the preferred choices for the treatment of TTI.…”

Le traitement chirurgical des terribles triades du coude : à propos d’une série rétrospective continue de 50 patients revus à 2 ans

“…Elle est indiquée pour les patients présentant une instabilité résiduelle après réparation des lésions latérales. Il existe toutefois peu de séries homogènes évaluant les résultats cliniques à long terme de ces réparations médiales(12,14,15). L'objectif principal de cette étude était d'évaluer les résultats cliniques du traitement chirurgical des TTC.…”