Can we treat select terrible triad injuries nonoperatively?

Area of Science:

• Orthopedic surgery
• Traumatology
• Sports medicine

Background:

• Terrible triad elbow injuries, involving ulnohumeral dislocation with radial head and coronoid fractures, are typically treated surgically.
• Previous studies on nonoperative management have been limited by small sample sizes.

Purpose of the Study:

• To evaluate functional outcomes, range of motion, strength, stability, radiographic union, arthritis, and complications in patients with terrible triad elbow injuries treated nonoperatively.
• To determine the efficacy and safety of nonoperative management for selected terrible triad elbow injuries.

Main Methods:

• Retrospective review of 12 patients with terrible triad elbow injuries treated nonoperatively between 2006 and 2012.
• Inclusion criteria: concentric reduction, non-obstructing radial head fracture, small coronoid fracture (Regan-Morrey Type 1 or 2), and stable arc of motion.
• Outcome measures included DASH and MEPI scores, physical examination for ROM and stability, strength testing, and radiographic assessment.

Main Results:

• At a mean follow-up of 36 months, patients reported good functional outcomes (DASH: 8.0 ± 11.0, MEPI: 94 ± 9).
• Elbows demonstrated a mean ROM of 134° flexion, 6° extension, 87° pronation, and 82° supination with no detected instability.
• Strength was preserved (mean 100% flexion, 89% extension, 79% pronation, 89% supination). Four patients developed arthritis, and two experienced complications requiring intervention.

Conclusions:

• Nonoperative treatment is a viable option for carefully selected terrible triad elbow injuries, offering good function and stable elbow ROM.
• Close clinical and radiographic follow-up is crucial to manage potential delayed complications such as subluxation or fracture displacement.