Posterior (Boyd) approach to terrible triad injuries

Area of Science:

• Orthopedic Surgery
• Traumatology
• Radiology

Background:

• Terrible triad injury of the elbow (TTIE) involves ulnohumeral dislocation, radial head fracture, and coronoid process fracture, leading to potential long-term elbow instability.
• The 'drop sign' (≥4 mm ulnohumeral distance) is a controversial radiographic indicator of potential postoperative instability and arthritis after TTIE.
• Standardized surgical stabilization is often required for TTIE, with a modified Boyd approach being an alternative to lateral approaches.

Purpose of the Study:

• To evaluate the incidence of the intraoperative 'drop sign' following surgical treatment of TTIE using a modified Boyd approach.
• To assess the effectiveness of this surgical technique in preventing postoperative instability.

Main Methods:

• Retrospective analysis of 23 acute TTIE cases treated by a single surgeon.
• Surgical treatment utilized a modified Boyd (posterior) elbow approach.
• Intraoperative fluoroscopic images were reviewed to identify the presence of a 'drop sign'.

Main Results:

• No 'drop signs' were observed on intraoperative imaging in any of the 23 treated TTIEs.
• No patients experienced redislocation, required reoperation, or reported instability symptoms during follow-up.
• The modified Boyd approach demonstrated a lack of intraoperative 'drop signs' in this cohort.

Conclusions:

• Standardized stabilization of TTIE using a modified Boyd approach resulted in zero instances of the intraoperative 'drop sign'.
• This surgical technique appears to effectively prevent radiographic signs of instability at the time of surgery.
• The findings suggest the modified Boyd approach is a reliable method for managing TTIE without intraoperative instability indicators.