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Risk of Subluxation or Dislocation After Operative Treatment of Terrible Triad Injuries
Dafang Zhang1, Matthew Tarabochia, Stein Janssen
1*Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA; †Harvard Medical School, Boston, MA; and ‡Dell Medical School, University of Texas, Austin, TX.
Objective:
The management of terrible triad injuries has evolved over the last 2 decades to include routine radial head fixation or replacement, reattachment of the lateral collateral ligament, with or without coronoid fixation. Our objective was to determine the likelihood of and factors associated with subluxation or dislocation after operative treatment of terrible triad injuries among a large group of surgeons using current techniques.
Design:
Retrospective cohort study.
Setting:
Two level I trauma centers.
Patients/Participants:
A total of 107 patients with operatively treated terrible triad injuries from January 2000 to June 2015.
Intervention:
Review of patient- and surgery-related factors during the first postoperative month.
Main Outcome Measurement:
Radiographic subluxation of the ulnohumeral joint.
Results:
One hundred of the 107 patients (93%) treated with open fixation of terrible triad injuries had no radiographic subluxation or redislocation. Two patients (2%) had slight transient radiographic subluxation ("drop sign") that corrected with active exercises within weeks of surgery. Five patients (5%) had persistent radiographic subluxation, 3 treated with a second surgery (3%). When treated within 2 weeks of injury, recurrent subluxation or dislocation after operative fixation of terrible triad injuries was rare (1%), provided that the radial head was replaced and the lateral collateral ligament reattached.
Conclusions:
Radiographic subluxation is very uncommon with current operative management of terrible triad injuries of the elbow within 2 weeks. Patients treated more than 2 weeks after injury might benefit from ancillary fixation to limit subluxation (ie, cross pinning, external fixation, or internal joint stabilizer).
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
