Mathew PK, Athwal GS, King GJ. Epub 2019 Aug 9. Key words Terrible, triad, elbow, fracture, instability. Indian J Orthop. 0000003233 00000 n PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. If left untreated, they commonly result in functional compromise and poor outcomes. Bohn K, Ipaktchi K, Livermore M, Cao J, Banegas R. Orthopedics. Forthman C, Henket M, Ring DC. Hongwei Chen*and Guolin Wu Department of Orthopedics, Yiwu Central Hospital, Yiwu, Zhejiang Province, PR China *Corresponding Author: 1. 0000001668 00000 n Mid-Term Postoperative Outcomes Following a Standardized Protocol. 21. 0000012843 00000 n 0000016448 00000 n 0000001156 00000 n 0000001940 00000 n Int Orthop. See more ideas about dislocation, elbow, treatment. The terrible triad primarily occurs in adults; the flexibility of ligaments in children make this constellation unlikely 4.. Fracture dislocation of the elbow, termed terrible triad, involves three anatomic injuries: coronoid fracture, radial head fracture, and posterior elbow dislocation. Elbow fracture-dislocations destabilize the elbow, preventing functional rehabilitation. Lateral Approach Versus Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis. Clipboard, Search History, and several other advanced features are temporarily unavailable. A terrible triad injury of the elbow consists of an ulnohumeral dislocation with associated fractures of the coronoid and radial head. 0000003802 00000 n Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome. Meena MK, Singh K, Meena S, Kumbhare C, Chouhan D. Bull Emerg Trauma. 2014 Feb;33(1):63-6. doi: 10.1016/j.main.2013.11.005. This site needs JavaScript to work properly. Mirouse G, Corcos P, Casabianca L, Guillon P. Chir Main. PubMed PMID: 19264707. The "terrible triad" injury is classically described as a combination of a coronoid process and radial head fractures, as well as a … Epub 2013 Dec 12. 0000048933 00000 n protocols. concepts. 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. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? 0000049006 00000 n 0000002959 00000 n Terrible Triad Injury of the Elbow: Current Concepts. Orthopaedic & Sports Medicine Grand Rounds - February 3, 2016 - Terrible Triad Injuries and the Complex Elbow: Current Concepts Presented by: Daphne M. Beingessner, MSc, MD, FRCSC Associate Professor of Traumatology Harborview Medical Center Dept. 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; 100 43 Dodds SD, Fishler T (2013) Terrible triad of the elbow. Terrible Triad Injury of the Elbow: Current Concepts 140Journal of the American Academy of Orthopaedic Surgeons structures of the elbow begin to fail from lateral to medial.24The anterior bundle of the MCL is postulated to be the last to fail; therefore, an el- bow can theoretically dislocate with- out a complete tear of this structure. When nonsurgical treatment is to be undertaken, several specific criteria must be met. %PDF-1.4 %���� 1 Introduction. Orthop Clin North Am 44: 47–58. Terrible triad injury of the elbow: current concepts. Reconstruction of pediatric hand defects and injuries. 0000049289 00000 n 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. doi: 10.2106/JBJS.OA.19.00017. Terrible triad injury of the elbow: how to improve outcomes? National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. In some accidents, the elbow dislocates (the radius and ulna are pulled apart from the humerus) without any bones breaking; surgeons call this injury … 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. 0000010098 00000 n 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. 0000003908 00000 n Terrible triad injury of the elbow: current . 2020 Oct 29;9(11):3500. doi: 10.3390/jcm9113500. A review. %%EOF 0000002217 00000 n 19. 2014;37(12):831-837. van Riet RP, Morrey BF. 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. h�b```e``������8�A��2l,=n@IG�������� �3d�����}B�z��������fzm��T3��(�UY�����N���"��L&Mth���]���M汧VB�xa L��⒗��م�! 0000009316 00000 n View Article Google Scholar 3. 2019 Oct;22(5):255-260. doi: 10.1016/j.cjtee.2019.05.005. 0000003156 00000 n 0000015536 00000 n 0000000016 00000 n 0000048894 00000 n Chemama B, Bonnevialle N, Peter O, Mansat P, Bonnevialle P. Orthop Traumatol Surg Res. ;8EDA��� ��`[1��E���"t�Bʕ� ,uh�F�ԕ �՚��e��I. 0000005408 00000 n 2009 Mar;17(3):137- 51. Review. Pipicelli JG, Chinchalkar SJ, Grewal R, Athwal GS. trailer 2014 Jul;472(7):2084-91. doi: 10.1007/s11999-014-3471-7. 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.  |  Total elbow arthroplasty. Epub 2010 May 8. Review. Advances in knowledge combined with improved implants and surgical techniques have contributed to better outcomes. The terrible triad of the elbow is characterized by great potential for joint instability and an unfavorable prognosis.1, 5Surgical treatment is the therapy of choice in the vast majority of cases, with the aims of restoration of the anatomy and early mobility. A delay in treatment or revision surgery resulted in a 20% greater loss of … 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/. <]/Prev 879955>> 2019 Nov 8;4(4):e0017. 2011 Jun;35(6):851-60. 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. This objective remains a challenge for surgeons due to the complexity of the lesion.5 Documentation of associated injuries occurring with radial head fracture. 0000033983 00000 n The primary goal of surgical fixation is to stabilize the elbow to permit early motion. Clin Orthop Relat Res. Fracture-dislocations of the elbow remain among the most difficult injuries to manage. View Article 0000049079 00000 n 0000006693 00000 n  |  Current treatment concepts for "terrible triad" injuries of the elbow. 2020 Mar 19;54(Suppl 2):254-259. doi: 10.1007/s43465-020-00090-x. 20. 0000033780 00000 n Wrist reconstruction including fusion. 0000003077 00000 n 2009 Mar. eCollection 2019 Oct-Dec. Chin J Traumatol. 2: Mathew PK, Athwal GS, King GJ. Mathew PK, Athwal GS, King GJ. Biomechanical study of the elbow following excision of the radial head. 0000002922 00000 n Pugh and McKee 27 reported a mean arc of flexion of between 20° and 135° and mean rotation of 135°. This injury almost always renders the elbow unstable requiring surgical intervention. Injury. 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. Morrey BF, Chao EY, Hui FC. 2014 Dec;37(12):831-7. doi: 10.3928/01477447-20141124-06. 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