NIH Please enable it to take advantage of the complete set of features! 0000003713 00000 n This objective remains a challenge for surgeons due to the complexity of the lesion.5  |  Terrible Triad Injury of the Elbow: Current Concepts. 0000049006 00000 n Reconstruction of pediatric hand defects and injuries. If left untreated, they commonly result in functional compromise and poor outcomes. Orthop Clin North Am 44: 47–58. Relatively few studies have documented the outcomes of terrible triad injuries of the elbow. 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. Indian J Orthop. Mirouse G, Corcos P, Casabianca L, Guillon P. Chir Main. 0000049289 00000 n protocols. 2009;17(3):137-51. concepts. Terrible triad injury of the elbow: current concepts. Outcomes after terrible triads of the elbow treated with the current surgical . 2014;37(12):831-837. van Riet RP, Morrey BF. 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. 0000001668 00000 n 1 Introduction. 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. The terrible triad primarily occurs in adults; the flexibility of ligaments in children make this constellation unlikely 4.. 0000003077 00000 n Sep 19, 2016 - Treatment of dislocated elbow. 2019 Nov 8;4(4):e0017. 2010 Apr;96(2):147-54. doi: 10.1016/j.rcot.2010.02.008. xref 0000006129 00000 n Int Orthop. 0000003012 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/. 0000028049 00000 n Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently … 0000011486 00000 n 0000003908 00000 n The injury is characterized by elbow instability and development of arthrosis and joint stiffness. Mid-Term Postoperative Outcomes Following a Standardized Protocol. 100 43 0000010818 00000 n %%EOF trailer Terrible triad injury of the elbow: current . 0000006693 00000 n Bohn K, Ipaktchi K, Livermore M, Cao J, Banegas R. Orthopedics. Elbow dislocation with intra-articular fracture: the results of operative treatment without repair of the medial collateral ligament. NLM An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. 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. 0000012131 00000 n Pathology The origins of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) complexes avulse from the epicondyles and the 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 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. Arthritis reconstruction of the thumb and fingers. 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. Clin Orthop Relat Res. 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. Dodds SD, Fishler T (2013) Terrible triad of the elbow. Broberg MA, Morrey BF. 0000009316 00000 n Hotchkiss introduced this concept 1996 5; Zhang et … 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. The primary goal of surgical fixation is to stabilize the elbow to permit early motion. 2008;466(1):130-134. 0000001940 00000 n When nonsurgical treatment is to be undertaken, several specific criteria must be met. Advances in knowledge combined with improved implants and surgical techniques have contributed to better outcomes. eCollection 2020 Dec. J Clin Med. Chemama B, Bonnevialle N, Peter O, Mansat P, Bonnevialle P. Orthop Traumatol Surg Res. 0000002959 00000 n 2011 Dec;15(4):198-208. doi: 10.1097/BTH.0b013e31822911fd. 0000003156 00000 n Clipboard, Search History, and several other advanced features are temporarily unavailable. 2014 Dec;37(12):831-7. doi: 10.3928/01477447-20141124-06. If left untreated, they commonly result in functional compromise and poor outcomes. 1979;61(1):63-8. 0000002217 00000 n 2: Mathew PK, Athwal GS, King GJ. Clin Orthop Relat Res. 0000034939 00000 n A terrible triad combines three injuries: dislocation of the elbow, fracture of the radial head, and fracture of the coronoid. J Am Acad Orthop Surg. 3), and is often associated with collateral ligaments injuries. 20. 0000005408 00000 n 2008 Dec;39(12):132937. 0000016448 00000 n Terrible triad injury of the elbow: current concepts Fracture-dislocations of the elbow remain among the most difficult injuries to manage. In general, terrible triad injuries are the result of a fall onto an outstretched hand. 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.  |  In some accidents, the elbow dislocates (the radius and ulna are pulled apart from the humerus) without any bones breaking; surgeons call this injury … 0000020945 00000 n 0 Mathew PK, Athwal GS, King GJ (2009) Terrible triad injury of the elbow: current concepts. Current elbow fracture dislocation classification systems only describe one element of the injury, or only include one pattern of elbow fracture dislocation. Epub 2019 Aug 9. USA.gov. Mathew PK, Athwal GS, King GJ. Current treatment concepts for "terrible triad" injuries of the elbow. 0000003802 00000 n Hongwei Chen*and Guolin Wu Department of Orthopedics, Yiwu Central Hospital, Yiwu, Zhejiang Province, PR China *Corresponding Author: 1. <]/Prev 879955>> - 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; ;8EDA��� ��`[1��E���"t�Bʕ� ,uh�F�ԕ �՚��e��I. concepts. startxref Morrey BF, Chao EY, Hui FC. Injury. 21. 142 0 obj <>stream National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Bohn K, Ipaktchi K, Livermore M, Cao J, Banegas R. Current treatment concepts for “terrible triad” injuries of the elbow. Total elbow arthroplasty. Fracture-dislocations of the elbow remain among the most difficult injuries to manage. Epidemiology. View Article Google Scholar 3. 2009 Mar;17(3):137- 51. Review. Terrible triad injury of the elbow: how to improve outcomes? J Am Acad Orthop Surg. Pipicelli JG, Chinchalkar SJ, Grewal R, Athwal GS. 2009 Mar. 19. Fracture dislocation of the elbow, termed terrible triad, involves three anatomic injuries: coronoid fracture, radial head fracture, and posterior elbow dislocation. - Epub 2008 Aug Hongwei Chen Department of Orthopedics Yiwu Central Hospital, PR China Accepted onJanuary 11, 2017 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. Documentation of associated injuries occurring with radial head fracture. J Am Acad Orthop Surg. 0000008153 00000 n Tech Hand Up Extrem Surg. 2014 Jul;472(7):2084-91. doi: 10.1007/s11999-014-3471-7. h�b```e``������8�A��2l,=n@IG�������� �3d�����}B�z��������fzm��T3��(�UY�����N���"��L&Mth���]���M汧VB�xa L��⒗��م�! 0000003233 00000 n Rehabilitation considerations in the management of terrible triad injury to the elbow. 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. 0000002922 00000 n 0000001750 00000 n 0000001156 00000 n 0000048933 00000 n 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.. Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome. 3: Ring D. Displaced, unstable fractures of the radial head: fixation vs. replacement--what is the evidence? JB JS Open Access. Mathew PK, Athwal GS, King GJ. 100 0 obj <> endobj 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. Background: Terrible triad injury (TTI), one of the main patterns of complex elbow instability, is difficult to treat and yields conflicting surgical results. 2019 Oct;22(5):255-260. doi: 10.1016/j.cjtee.2019.05.005. 2020 Oct 29;9(11):3500. doi: 10.3390/jcm9113500. 2011 Jun;35(6):851-60. Current treatment concepts for "terrible triad" injuries of the elbow. Buttress plate fixation of coronoid process fractures via a medial approach. Forthman C, Henket M, Ring DC. COVID-19 is an emerging, rapidly evolving situation. A terrible triad injury of the elbow consists of an ulnohumeral dislocation with associated fractures of the coronoid and radial head. Wrist reconstruction including fusion. 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. 2020 Jan;8(1):4-9. doi: 10.29252/beat-080102. [Posteromedial dislocation of the elbow with lateral condyle and coronoid process fractures: a case report]. doi: 10.2106/JBJS.OA.19.00017. A review. PubMed PMID: 19264707. A delay in treatment or revision surgery resulted in a 20% greater loss of … 0000031488 00000 n Biomechanical study of the elbow following excision of the radial head. 0000012843 00000 n 0000008532 00000 n Key words Terrible, triad, elbow, fracture, instability.  |  J Hand Surg Am. Terrible triad injuries are difficult to manage and historically have poor outcomes. 0000049079 00000 n 2020 Mar 19;54(Suppl 2):254-259. doi: 10.1007/s43465-020-00090-x. Terrible triad injury of the elbow: current . J Am Acad Orthop Surg. Some circumstantial evidence supports this concept. Elbow fracture-dislocations destabilize the elbow, preventing functional rehabilitation. 17 (3):137-51. . Orthopedics. The "terrible triad" injury is classically described as a combination of a coronoid process and radial head fractures, as well as a … Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. 0000000016 00000 n PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. 2007 Oct. 32 (8):1200-9. Radiographic Predictors of Medial Collateral Ligament Injury and Stability of the Elbow. Does the Coronoid Always Need to Be Fixed in Terrible Triad Injuries of the Elbow? 0000033780 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. Epub 2010 May 8. Review. Epub 2013 Dec 12. 0000007501 00000 n 0000010098 00000 n Repair of tendon, artery and skeletal injuries. This injury almost always renders the elbow unstable requiring surgical intervention. 0000048894 00000 n J Bone Joint Surg Am. terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation. should instability persist after addressing the radial head and the LCL complex in the presence of a small coronoid fracture, the next best step is MCL reconstruction. 2014 Feb;33(1):63-6. doi: 10.1016/j.main.2013.11.005. 0000033983 00000 n of Orthopaedics and Sports Medicine University of Washington School of Medicine eCollection 2019 Oct-Dec. Chin J Traumatol. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. See more ideas about dislocation, elbow, treatment. 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. Bohn K, Ipaktchi K, Livermore M, Cao J, Banegas R. Elbow fracture-dislocations destabilize the elbow, preventing functional rehabilitation. 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. 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