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Risk of Subluxation or Dislocation After Operative Treatment of Terrible Triad Injuries.

Dafang Zhang1, Matthew Tarabochia, Stein Janssen

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Operative treatment for terrible triad elbow injuries rarely leads to subluxation when performed within two weeks. Early fixation of the radial head and lateral collateral ligament is key to preventing instability.

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Area of Science:

  • Orthopedic Surgery
  • Trauma Management
  • Elbow Biomechanics

Background:

  • Terrible triad elbow injuries involve disruption of the ulnohumeral and radiocapitellar joints.
  • Management has evolved to include radial head fixation/replacement and lateral collateral ligament repair.

Purpose of the Study:

  • To assess the incidence and predictors of elbow subluxation after surgical treatment of terrible triad injuries.
  • To evaluate current surgical techniques for terrible triad injuries.

Main Methods:

  • Retrospective cohort study of 107 patients with operatively treated terrible triad injuries.
  • Data collected from two level I trauma centers between January 2000 and June 2015.
  • Analysis of patient and surgery factors within the first postoperative month, focusing on radiographic ulnohumeral joint subluxation.

Main Results:

  • 93% of patients (100/107) experienced no radiographic subluxation or redislocation.
  • Only 2% had transient subluxation, and 5% had persistent subluxation requiring further intervention.
  • Recurrent subluxation was rare (1%) when treated within 2 weeks with radial head replacement and lateral collateral ligament reattachment.

Conclusions:

  • Current operative management for terrible triad elbow injuries within 2 weeks has a low rate of radiographic subluxation.
  • Patients treated later than 2 weeks may benefit from additional fixation methods to prevent subluxation.