TERRIBLE TRIAD OF THE ELBOW: EVALUATION OF SURGICAL TREATMENT

Area of Science:

• Orthopedic Surgery
• Traumatology
• Elbow Biomechanics

Background:

• The terrible triad of the elbow involves fracture-dislocation with coronoid process and radial head involvement.
• This severe injury pattern presents significant challenges in orthopedic treatment and patient recovery.

Purpose of the Study:

• To evaluate the epidemiology and surgical outcomes of treating elbow fracture-dislocations specifically in terrible triad injuries.
• To identify factors influencing successful surgical management and clinical results in these complex cases.

Main Methods:

• Retrospective analysis of 19 patients (12 male, 7 female) with terrible triad elbow injuries.
• Data collected included injury mechanism, fracture patterns, surgical timing, and procedure type.
• Clinical assessment involved measuring elbow range of motion and applying the MEPS questionnaire.

Main Results:

• A fall from height was the most common injury mechanism.
• All patients underwent surgery, with a mean delay of 16.1 days.
• At a mean follow-up of 50.3 months, 79% achieved excellent or good results (MEPS score: 86), with mean motion of 112° (flexion-extension) and 127.9° (pronation-supination).
• Factors for good outcomes included surgery within 14 days, flexion-extension >100°, and flexion contracture <30°.
• Complications occurred in 5 patients (nerve issues, pseudarthrosis, instability).

Conclusions:

• Despite the severity, surgical intervention for the terrible triad elbow injury can lead to good stability and functional outcomes.
• Optimal surgical timing (within 14 days) and achieving specific functional ranges (flexion-extension >100°, contracture <30°) are crucial for successful recovery.