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Radial head replacement or repair for the terrible triad of the elbow: which procedure is better?
Mingming Yan1, Jiangdong Ni1, Deye Song1
1Department of Orthopaedic Surgery, Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Background:
The terrible triad of the elbow comprises an ulnar coronoid process fracture, a radial head (RH) fracture and posterior dislocation of the elbow. It is considered severe by many clinicians because it is difficult to repair and has a poor prognosis; therefore, it deserves more attention.
Methods:
Thirty-nine patients with terrible triad of the elbow characterized by a Mason type-III RH fracture were randomly divided into either an RH repair group (n = 19) or an RH replacement group (n = 20). The complication rates, radiological outcomes, Mayo Elbow Performance Score and range of motion of the elbow were analysed.
Results:
Follow-up demonstrated no subluxation or recurrent dislocation of the elbow. Differences in surgery duration between the groups were significant (P < 0.001). The outcomes in terms of Mayo Elbow Performance Score (P = 0.009), flexion-extension arc (P = 0.01) and pronation-supination arc (P = 0.04) were significantly better in the RH replacement group. In addition, patients in the RH replacement group displayed significantly fewer post-surgery complications than those in the RH repair group (P = 0.04).
Conclusion:
Treating Mason type-III RH fracture in a terrible triad of the elbow with a metal RH prosthesis resulted in better clinical outcomes and fewer post-surgery complications than treating a terrible triad of the elbow by repairing it with screws or plates. RH replacement might be a more effective approach to better managing a terrible triad of the elbow.
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