1): S25-36. 2014; 37(12): 831-7. de Haan J, Schep N, Tuinebreijer W, den Hartog D. Complex and unstable simple elbow dislocations: A review and quantitative analysis of individual patient data. The terrible triad of the elbow is a difficult injury with historically poor outcomes. ", "There are many scientists who can not afford the rather expensive subscriptions to scientific journals. J Orthop Surg (Hong Kong) 2009; 17(3): 335-9. I read Open Access journals to keep abreast of the recent development in my field of study. A double incision technique is used if the radial head is to be fixed or if the surgeon tests stability after lateral reconstruction when deciding if to proceed to medial and coronoid repair. Ring D, Doornberg JN. ", "It is a modern trend for publishers to establish open access journals. Of these, the MCL is the primary stabilizer in flexion, and its removal will cause instability in all positions except extension [6]. Rehabilitation considerations in the management of terrible triad injury to the elbow. Posterior dislocation of the elbow with fractures of the radial head and coronoid process is known as the “terrible triad” because of inherent difficulty in treatment and high rate of complications. If a static external fixator is used it should be limited to less than three weeks because of the propensity of the joint to become stiff. The articles are high standard and cover a wide area. Usual technique is shown in Fig. These injuries were associated with high energy mechanisms. Broberg MA, Morrey BF. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals. Josefsson PO, Gentz CF, Johnell O, Wendeberg B. Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint. Complex elbow dislocations encompass a large range of injuries from dislocations associated with undisplaced radial head fractures to significant bony injuries causing chronic instability. Terrible triad injuries were initially treated with operative repair of all the damaged structures; LCL, Radial head, coronoid and MCL. O’Driscoll SW. Elbow dislocations. CT scanning as an adjunct to diagnosis is invaluable as the true nature of radial head and coronoid fractures may not be apparent on plain radiographs. Objective Terrible 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. 1962 Jun 1;31:51-6 Schwab GH, Bennett JB, Woods GW, Tullos HS. C.A. ", "Open access journals are probably one of the most important contributions to promote and diffuse science worldwide. As a relatively uncommon injury there are no randomised controlled trials in the literature to assess the best surgical algorithm. Clin Orthop Relat Res 2014; 472(7): 2092-9. Fractures and dislocations of the elbow. The elbow and its disorders. When used it should be followed by early mobilisation which is most effective at 30-120 degrees of active extension [54]. Terrible triad injuries of the elbow: Does the coronoid always need to be fixed? Chemama B, Bonnevialle N, Peter O, Mansat P, Bonnevialle P. Terrible triad injury of the elbow: How to improve outcomes? With the elbow in more flexion, this pattern can also cause an olecranon fracture. -, Instr Course Lect. Complex elbow dislocations are injuries with significant risk of long-term disability. Complications of treating terrible triad injury of the elbow: A systematic review. Therefore the presence of any concomitant fracture to the radius, ulna or humerus around the ipsilateral elbow joint is termed a complex dislocation [1]. ", "Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. COVID-19 is an emerging, rapidly evolving situation. Operative treatment is usually with tension band wiring or plate fixation followed by early mobilisation. The origins of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) complexes avulse from the epicondyles and the anterior capsule fails with a transverse fracture of the coronoid tip. -. There is no unifying classification system for complex dislocations or terrible triad injury. Wake H, Hashizume H, Nishida K, Inoue H, Nagayama N. Biomechanical analysis of the mechanism of elbow fracture-dislocations by compression force. Current Treatment Concepts for “Terrible Triad” Injuries of the Elbow. Repair can be carried out through a single lateral incision if the radial head is to be replaced, as the coronoid can be accessed through the defect left by the excised radial head. Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up. Elbow extension with forearm supination and added valgus stress puts most strain on the ulnohumeral joint, radial head and MCL respectively, causing a posterolateral rotational instability pattern of fracture-dislocation which includes posterior dislocation with a radial head fracture and the terrible triad injury with an added coronoid fracture. Traditionally the LCL, MCL, coronoid and radial head were reconstructed, but there is recent evidence to support repairing of the coronoid and MCL only if the elbow is unstable after reconstruction of lateral structures. This review includes a literature search of the current evidence and personal experiences of the authors in managing these injuries. doi: 10.3928/01477447-20150204-91. Loading in flexion over 30 degrees is more likely to instead produce an olecranon fracture. The creation of the trauma network in the UK has concentrated subspecialists geographically and this will lead to more opportunities for collaborative research in these relatively uncommon but severe injuries. Chung CH, Wang SJ, Chang YC, Wu SS. 1 and 2). Dynamic stability encompasses the congruity of the articulation when the muscles crossing the elbow joint contract to enable movement [7]. 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