Analysis of the effect of lateral approach combined with anteromedial approach for the treatment of terrible triad of the elbow injuries

Tian Xiangyu; Wu Han; Wu Xuejian

doi:10.3969/j.issn.1004-437X.2017.06.004

Abstract：Objective To investigate the effect of lateral approach combined with anteromedial approach for the treatment of terrible triad of the elbow injuries.Methods Data of 27 patients with terrible triad of the elbow injuries treated in the First Affiliated Hospital of Zhengzhou University using this modified surgical technique from September of 2011 to July of 2015 were retrospectively analyzed.According to ulna coronoid fracture Regan-Morrey typing, there were 10 cases of typeⅠ,14 of type Ⅱ,and 3 of type Ⅲ.According to Mason classification of radial head fracture, there were 5 cases of typeⅠ, 18 of type Ⅱ,and 4 of type Ⅲ.Surgical procedure included fixation or replacement of the radial head and repair of the ruptured lateral collateral ligament (LCL) through a lateral approach.Simultaneous fixation of the coronoid process and repair of medial collateral ligament (MCL) injury were performed through an anteromedial approach.After operation, 13 cases were provided with elbow joint flexion 90° and plaster fixation at neutral position of fore arms.Mayo elbow performance score (MEPS) was determined for each patient at the latest clinic visit.Results The mean follow-up period was 16 months (range, 11-28 months).At the latest follow-up, the mean flexion-extension arc of the elbow was 121°(range, 90°-140°) and the mean forearm rotation was 136°(range, 100°-150°).The mean MEPS was 91 points (range, 70-100 points), with 20 excellent results, 5 good results and 2 middle results.The excellent and good rate was 93％.Conclusion Lateral approach combined with anteromedial approach for terrible triad of the elbow can fully exposure the surgery field, and provid both bony and soft-tissue stability, thereby allowing early active motion as well as function recovery of the elbow.