100 43 Chemama B, Bonnevialle N, Peter O, Mansat P, Bonnevialle P. Orthop Traumatol Surg Res. 17 (3):137-51. . trailer 19. %%EOF concepts. 2009 Mar;17(3):137- 51. Review. The injury is characterized by elbow instability and development of arthrosis and joint stiffness. View Article Google Scholar 3. Dodds SD, Fishler T (2013) Terrible triad of the elbow. Fracture-dislocations of the elbow remain among the most difficult injuries to manage. 3), and is often associated with collateral ligaments injuries. The terrible triad of the elbow is defined as the combination of fractures of the radial head and ulnar coronoid process and dislocation of the elbow joint 4 (Fig. A new comprehensive classification system based on the three-column concept of elbow fracture dislocation is presented with a suggested algorithm for managing each injury pattern. 2020 Jan;8(1):4-9. doi: 10.29252/beat-080102. Epub 2013 Dec 12. 21. Epub 2019 Aug 9. 0000048933 00000 n 0000049079 00000 n 0000010098 00000 n 1 Introduction. The primary goal of surgical fixation is to stabilize the elbow to permit early motion. Meena MK, Singh K, Meena S, Kumbhare C, Chouhan D. Bull Emerg Trauma. A delay in treatment or revision surgery resulted in a 20% greater loss of … h�b```e``������8�A��2l,=n@IG�������� �3d�����}B�z��������fzm��T3��(�UY�����N���"��L&Mth���]���M汧VB�xa L��⒗��م�! An elbow dislocation associated with a displaced fracture of the radial head and coronoid process almost always renders the elbow unstable, making surgical fixation necessary. 0000000016 00000 n Rehabilitation considerations in the management of terrible triad injury to the elbow. 2020 Mar 19;54(Suppl 2):254-259. doi: 10.1007/s43465-020-00090-x. 0000003233 00000 n Advances in knowledge combined with improved implants and surgical techniques have contributed to better outcomes. 0000003156 00000 n 2009 Mar. An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. J Bone Joint Surg Am. Morrey BF, Chao EY, Hui FC. 0000033983 00000 n 0000006129 00000 n Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad. 2008;466(1):130-134. Mirouse G, Corcos P, Casabianca L, Guillon P. Chir Main. xref Sep 19, 2016 - Treatment of dislocated elbow. Total elbow arthroplasty. 0000049289 00000 n Lateral Approach Versus Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis. Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head. It is postulated that there is a posterolateral load upon the elbow during the fall, which results in tension failure of the LCL and the MCL, and a compressive load that fractures the radial head. 100 0 obj <> endobj 0000004662 00000 n 0000003908 00000 n Mathew PK, Athwal GS, King GJ. doi: 10.2106/JBJS.OA.19.00017. 0000010486 00000 n Tech Hand Up Extrem Surg. 0 Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. Broberg MA, Morrey BF. 0000049183 00000 n Terrible triad injury of the elbow: current concepts Fracture-dislocations of the elbow remain among the most difficult injuries to manage. JB JS Open Access. 2011 Jun;35(6):851-60. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Clin Orthop Relat Res. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. This injury almost always renders the elbow unstable requiring surgical intervention. 0000003802 00000 n The “terrible triad” injury is classically described as a combination of a coronoid process and radial head fractures, as well as a posterolateral elbow dislocation. Please enable it to take advantage of the complete set of features! Radiographic Predictors of Medial Collateral Ligament Injury and Stability of the Elbow. 2019 Nov 8;4(4):e0017. Elbow fracture-dislocations destabilize the elbow, preventing functional rehabilitation. NLM Clipboard, Search History, and several other advanced features are temporarily unavailable. Pathology %PDF-1.4 %���� Documentation of associated injuries occurring with radial head fracture. J Am Acad Orthop Surg. Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome. 0000009316 00000 n Mathew PK, Athwal GS, King GJ. 0000001750 00000 n J Am Acad Orthop Surg. J Am Acad Orthop Surg 17: 137–151. 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. 3: Ring D. Displaced, unstable fractures of the radial head: fixation vs. replacement--what is the evidence? Int Orthop. Terrible Triad Injury of the Elbow: Current Concepts. 0000003713 00000 n When nonsurgical treatment is to be undertaken, several specific criteria must be met. Bohn K, Ipaktchi K, Livermore M, Cao J, Banegas R. Orthopedics. Current elbow fracture dislocation classification systems only describe one element of the injury, or only include one pattern of elbow fracture dislocation. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. 20. Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament. Bohn K, Ipaktchi K, Livermore M, Cao J, Banegas R. Current treatment concepts for “terrible triad” injuries of the elbow. 2014 Feb;33(1):63-6. doi: 10.1016/j.main.2013.11.005. Biomechanical study of the elbow following excision of the radial head. 0000003012 00000 n In some accidents, the elbow dislocates (the radius and ulna are pulled apart from the humerus) without any bones breaking; surgeons call this injury … Epub 2010 May 8. Review. A terrible triad combines three injuries: dislocation of the elbow, fracture of the radial head, and fracture of the coronoid. 0000012131 00000 n Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently … Terrible triad injury of the elbow: current . 2007 Oct. 32 (8):1200-9.  |  0000002922 00000 n Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. NIH 0000016448 00000 n Hotchkiss introduced this concept 1996 5; Zhang et … Outcomes after terrible triads of the elbow treated with the current surgical . National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 0000015536 00000 n Mathew PK, Athwal GS, King GJ (2009) Terrible triad injury of the elbow: current concepts. 0000007501 00000 n - Discussion: - terrible triad: (RHF + MCL + coronoid process frx) + elbow dislocation - in this injury there is little to keep the elbow reduced; - general operative considerations: 1) radial head: repair or replacement of the radial head (see ORIF or radial head) - concomitant excision of radial head and coronoid process is not performed since it may result in marked instability; eCollection 2020 Dec. J Clin Med. 0000031488 00000 n 0000028049 00000 n ;8EDA��� ��`[1��E���"t�Bʕ� ,uh�F�ԕ �՚��e��I. 0000033780 00000 n 142 0 obj <>stream 2011 Dec;15(4):198-208. doi: 10.1097/BTH.0b013e31822911fd. 0000012843 00000 n COVID-19 is an emerging, rapidly evolving situation. Terrible triad injury of the elbow: how to improve outcomes? A review. 2010 Apr;96(2):147-54. doi: 10.1016/j.rcot.2010.02.008. We analyzed prospectively a series of patient affected by TTI and treated according to the current diagnostic and surgical protocols to investigate whether their application allow to obtain more predictable outcomes. The terrible triad injury of the elbow, dislocation of the ulnohumeral joint with fractures of the coronoid process and radial head, is difficult to treat and has a historically poor outcome. J Am Acad Orthop Surg. Does the Coronoid Always Need to Be Fixed in Terrible Triad Injuries of the Elbow? 0000020945 00000 n This objective remains a challenge for surgeons due to the complexity of the lesion.5 2009;17(3):137-51. 0000034939 00000 n The terrible triad primarily occurs in adults; the flexibility of ligaments in children make this constellation unlikely 4.. The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus.Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. J Hand Surg Am. 0000001668 00000 n 2020 Oct 29;9(11):3500. doi: 10.3390/jcm9113500. concepts. [Posteromedial dislocation of the elbow with lateral condyle and coronoid process fractures: a case report]. Reconstruction of pediatric hand defects and injuries. Buttress plate fixation of coronoid process fractures via a medial approach. Fracture dislocation of the elbow, termed terrible triad, involves three anatomic injuries: coronoid fracture, radial head fracture, and posterior elbow dislocation. - Epub 2008 Aug 0000011486 00000 n Terrible triad injuries are difficult to manage and historically have poor outcomes. Recent literature has improved our understanding of elbow anatomy and biomechanics along with the pathoanatomy of this injury, thereby allowing the development of a systematic approach for treatment and rehabilitation. Indian J Orthop. 2014 Jul;472(7):2084-91. doi: 10.1007/s11999-014-3471-7. 0000008532 00000 n 0000010818 00000 n See more ideas about dislocation, elbow, treatment. Clin Orthop Relat Res. The terrible triad of the elbow is a severe elbow fracture-dislocation pattern and is so-called because it has poor medium-to-long term outcome.. 2019 Oct;22(5):255-260. doi: 10.1016/j.cjtee.2019.05.005. Repair of tendon, artery and skeletal injuries. Orthop Clin North Am 44: 47–58. T HE TERRIBLE TRIAD OF THE ELBOW is posterior or posterolateral dislocation of the ulnohumeral joint with fractures of the radial head and coronoid process. : 10.1007/s43465-020-00090-x 20449590 ; pubmed Central PMCID: PMC3103950 to permit early motion functional... 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