Management of Elbow Terrible Triad Injuries: A Comprehensive Review and Update.

Area of Science:

• Orthopaedic Surgery
• Elbow Trauma
• Biomechanics

Background:

• The terrible triad of the elbow (dislocation, radial head fracture, coronoid fracture) presents significant management challenges.
• These injuries typically result from a fall onto an outstretched hand, causing posterolateral rotatory force and failure of elbow stabilizing structures.
• Despite surgical interventions, persistent instability and functional loss can occur.

Purpose of the Study:

• To provide orthopaedic surgeons with a fundamental understanding of terrible triad elbow injuries.
• To guide management principles by integrating established practices with emerging approaches.
• To improve patient outcomes by addressing challenges in complex elbow trauma.

Main Methods:

• Review of established surgical techniques for elbow stabilization, including lateral ligament repair, radial head fixation/replacement, and coronoid fixation.
• Discussion of internal versus external fixation options for severe instability.
• Emphasis on early range of motion in rehabilitation to prevent stiffness.

Main Results:

• Surgical repair often involves addressing multiple components: lateral complex, radial head, coronoid process, and potentially medial structures.
• Rehabilitation protocols focus on early motion to mitigate stiffness, a common post-injury complication.
• Integrated management strategies aim to reduce persistent instability and functional deficits.

Conclusions:

• Effective management of the terrible triad requires a comprehensive understanding of elbow biomechanics and injury patterns.
• A combination of surgical repair and diligent rehabilitation is crucial for restoring function.
• Adopting integrated approaches can enhance outcomes for these complex elbow injuries.