Diagnosis and treatment of“terrible triad” of elbow joint

CHEN Hui; GUO Qing-shan; LIU Hua-yu; ZONG Zhao-wen; SHEN Yue

Abstract：Objective We retrospectively analyzed the clinical features of 13 patients with “terrible triad”injury of elbow,so as to investigate its diagnosis ,treatment and postoperative rehabilitation .Methods From Mar. 2010 to Sep.2013,13 patients with “terrible triad” injury of elbow were treated with internal and external fixation . The Mason and Hotchkiss classification for radial head fractures indicated 7 cases of type Ⅰ,4 cases of type Ⅱ,and 2 cases of type Ⅲ.The Regan and Morry classification for fractures of ulna coronoid process indicated 4 cases of type Ⅰ,6 cases of type Ⅱand 3 cases of type Ⅲ.In addition ,all cases were associated with elbow medial collater-al ligament sprain .2.0-mm,2.7-mm and 3.0-mm screws were used to fix the coronoid process fracture and radial head fractures ,respectively .Two patients with comminuted fracture of radial head were taken radial head replace-ment.Medial and lateral collateral ligament injury was treated with suture anchors fixation .The 13 cases were ex-ternally fixed at 90°of elbow flexion with the forearm in neutral rotation .Postoperative flexion exercises were taken with external fixation to protect the downstream of elbow joint ,and active flexion and rotation function exercises were taken 4 weeks after operation .Results The 3 months to 3 years follow-up showed fracture healed ,elbow joint sta-ble and no pain in all the 13 cases,the average elbow flexion and forearm rotation was 120 °,and the average forearm rotation was 110 °.According to the Mayo score system ,there were 10 cases of excellent,2 cases of good,and 1 case of poor .Conclusion “Terrible triad” injury of the elbow is a type of injury combining with radial head and coronoid process fracture ,and medial and lateral collateral ligament injury of the elbow ,in which the elbow stability is poor .The elbow function can obtain satisfactory results only through stable structure reconstruction of bone and ligament and early functional exercise .