Terrible triad of the elbow: is it still a troublesome injury?

Giannicola, Giuseppe; Calella, Piergiorgio; Piccioli, Andrea; Scacchi, Marco; Gumina, Stefano

doi:10.1016/s0020-1383(15)30058-9

Cited by 54 publications

(49 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Watters et al [3] stated that REC was performed when ‘there were fewer than four articular fragments; otherwise, it was replaced’. Although specific indications were not described by Giannicola et al REC was performed in all, but 1 patient with a Mason II fracture and REP performed in all, but 2 patients with a Mason III fracture in their study [4]. Yan et al [17] again did not describe specific indications, but all 39 patients included within their study had a Mason III fracture of the radial head, of which 20 underwent REP and 19 REC.…”

Section: Resultsmentioning

confidence: 94%

“…58% of the patients were male and 42% were female. Four studies [2, 4, 14, 18] provided individual data regarding gender distribution between the two cohorts. From these studies, 58% of patients were male in the REP cohort and 67% were male in the REC cohort.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies [14, 15, 18] found the mean MEPS to be greater in the REC group and three favoured REP [4, 13, 17]. Across the six studies which reported MEPS, the mean for the REP group was 88.6 (range 60–97) and 88.5 for REC group (range 55–95).…”

Section: Resultsmentioning

confidence: 99%

“…Of these, 5 were excluded, as they were published more than 10 years ago, 2 were excluded, because they were not printed in English, 1 was excluded, because the full article text could not be sourced, and 1 was excluded, because it was missed as a duplicate in the initial screening process. Of the 19 remaining articles, only 9 [2–4, 13–18] had sufficient data to make a quantitative comparison between REP and REC based upon the outcomes of interest (Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

“…As a result of the unstable nature of this injury, conservative management is rarely a viable option with high failure rates and patients suffering from chronically unstable, painful, and stiff elbow. It is, therefore, widely accepted that the management of TTIE should be operative in the vast majority of cases [4]. …”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Radial head replacement versus reconstruction for the treatment of the terrible triad injury of the elbow: a systematic review and meta-analysis

Kyriacou

Gupta

Bains

et al. 2019

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

IntroductionThe terrible triad injury of the elbow (TTIE) remains challenging to manage and has been associated with high complication rates and poor outcomes. There is a trend towards performing radial head replacement (REP) in preference to radial head reconstruction (REC) as arthroplasty provides early stability and may allow mobilisation sooner, potentially resulting in a better functional outcome. This systematic review compares the outcome of patients with TTIE treated with either REC or REP.Materials and methodsMEDLINE, Embase, and CINAHL were searched for studies published in English involving at least ten patients exclusively with a TTIE managed operatively, including both patients with either REC or REP. Data collection was in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis protocol. The outcomes of interest were Mayo Elbow Performance Score (MEPS) and range of motion (ROM). Post-operative complications were also compared.Results9 studies involving 210 patients were included (98 REPs and 112 RECs). There was no statistically significant difference (p = 0.51) demonstrated between in the mean MEPS of the REP group (mean 88.6) and REC group (mean 88.5). Similarly, there was no statistically significant difference demonstrated between the REP and REC groups in terms of ROM. The risk of re-operation was high in both the REP (18.4%) and REC (17.9%) group. The overall complication rate of all patients included in the study was high (65%).ConclusionsComparable results with good outcomes in terms of functional scores and ROM can be achieved with both REP and REC when treating TTIE, although the re-operation rate for both remains relatively high. Given there is no apparent clear advantage between the two treatment groups, we would suggest that REC should be performed when a satisfactory fixation can be achieved as the longevity of REP in young patients with a TTIE is currently uncertain.

show abstract

Section: Resultsmentioning

confidence: 94%