The terrible triad includes a posterior dislocation of the elbow with radial head and coronoid fractures, concurrent ligament injuries are very common especially the LCL and medial collateral ligament (MCL), which can be the source of a definite instability [1, 2]. Published by Elsevier Inc. All rights reserved. Fractures and dislocations of the elbow. Terrible; elbow; fracture; instability; triad. Six months after the accident, the patient made a good recovery. Resection of radial head alone is contraindicated.  |  Bilateral elbow dislocation in relation to Essex-Lopresti injury. By Joaquin Sanchez-Sotelo 58 Videos. No ligament reconstruction . Abstract. We present a particular case by the unique association of two rare injuries: a terrible triad of the elbow and an ipsilateral Essex-Lopresti entity. 3). (A) X-ray of elbow profile shows the posterior elbow dislocation with a detached anterior fragment from the coronoid; (B) three-fourth X-ray of the forearm before the reduction demonstrates significant ulnar negative variance. The purpose of treatment in the terrible triad injury is to restore the congruency of the elbow joint, its stability and an optimal ROM. 5 patients: dislocated for 2 to 9 months . A 56-year-old male fell forward onto his forearm and elbow during a mountain walk. The elbow was stable, and the grip strength was comparable to the contralateral side (Fig. Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad. 2018 Jul;10(3):216-222. doi: 10.1177/1758573217713694. We managed a surgical treatment the second day of admission. The authors declare there is no financial support from any organism. Radial head fixation and arthroplasty, coronoid process fixation, and repair of the lateral collateral ligament continue to be the mainstays of treatment. Shoulder Elbow. This course of physical therapy successfully treat a undisplaced terrible triad injury in very limited selected supervised patients. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Radial head fixation and arthroplasty, coronoid process fixation, and repair of the lateral collateral ligament continue to be the mainstays of treatment. Does Timing of Surgery Affect Treatment of the Terrible Triad of the Elbow? Epub 2017 Jun 13. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. In some accidents, the elbow dislocates (the radius and ulna are pulled apart from the humerus) without any bones breaking; surgeons call this injury a “simple dislocation”. Mid-Term Postoperative Outcomes Following a Standardized Protocol. The elbow dislocation is a frequent and an easily diagnosed pattern, at the opposite of the DRUJ dislocation, which is often missed in the emergency department if an adequate physical exam with the appropriate radiographs is not carried out [3]. J Clin Med. (iv) Early elbow mobilization is started to avoid the stiffness. A high index of suspicion with a detailed examination of the elbow, forearm and wrist associated to a comprehensive imaging were mandatory for a complete diagnosis and an adequate treatment. The lateral collateral ligament (LCL) and the common extensor muscle were repaired. Terrible triad … There was mild widening of the DRUJ with significant ulnar negative variance (Fig. Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. Copyright © 2020 Oxford University Press and JSCR Publishing Ltd. 1 Introduction Fracture dislocation of the elbow , termed terrible triad , involves three anatomic injuries: coronoid fracture, radial head fracture , and posterior elbow dislocation. Generally these should commence around day 7-10 for a terrible triad or elbow dislocation unless otherwise specified in the operating report. At 8 months of follow-up and 2 months of physiotherapy, the patient made a good recovery in regard to pain and mobility. Keywords: Surgical management is quite standardized according to Pugh et al. Chronic Simple Elbow Dislocation . Chan K, MacDermid JC, Faber KJ, King GJ, Athwal GS. of “terrible triad of the elbow”, which was first described by Hotchkiss in 19961, is a severe pattern of elbow fracture-dislocation injury that consists of posterior dis- … 20:08. The elbow testing objected a stable elbow from −30° of extension to complete flexion. Additionally, it restores the lateral column of the elbow, acting to tension the repaired lateral ligaments resisting varus and posterolateral rotatory instability. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. The terrible triad of the elbow and the Essex-Lopresti are two rare injuries but their association is unique [1, 2]. Does the Coronoid Always Need to Be Fixed in Terrible Triad Injuries of the Elbow? Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. - Terrible triad injury of the elbow: how to improve outcomes? This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, A rare case of fat embolism syndrome secondary to abdominal liposuction and gluteal fat infiltration, The use of radiolucent (carbon fibre-reinforced polymer) pedicle screw fixation for serial monitoring of clear cell meningioma: a case report, Type A aortic dissection after ‘zone 0’ thoracic endovascular aortic repair for type 1 hybrid aortic arch replacement of arch aneurysm, Spontaneous intestinal bleeding due to pseudoaneurism of the gastroduodenal artery: case report of a rare complication to median arcuate ligament syndrome, Two cases of giant peritoneal inclusion cysts requiring treatment after total laparoscopic hysterectomy, Volume 2020, Issue 12, December 2020 (In Progress), http://creativecommons.org/licenses/by-nc/4.0/, Receive exclusive offers and updates from Oxford Academic, Paediatric medial epicondyle fracture without elbow dislocation associated with intra-articular ulnar nerve entrapment, A rare case of Elbow dislocation with medial epicondyle fracture associated to ulnar neuropraxia, A rare three part proximal ulnar shear fracture requiring innovative reduction and fixation in a paediatric elbow, Desmoplastic fibroma of the distal radius: an interesting case and a review of the literature and therapeutic implications. He reported immediate swelling and pain in his elbow and wrist. terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation. A terrible triad combines three injuries: dislocation of the elbow, fracture of the radial head, and fracture of the coronoid. Romero Pérez B, Marcos García A, Medina Henríquez JA, Muratore Moreno G. Oxford University Press is a department of the University of Oxford. Please enable it to take advantage of the complete set of features! Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). No similar case has been found in the literature review. 2020 Oct 29;9(11):3500. doi: 10.3390/jcm9113500. Early management is a favourable prognostic factor for final outcome. The treatment of terrible triad injuries of the elbow continues to evolve. Correspondence address. The use of a hinged external protection is recommended as it allows quick articular mobilization [8]. Understanding the The terrible triad refers to three combined lesions: elbow dislocation, radial head and coronoid fractures [ 2, 3 ]. If plain radiographs are inconclusive or there is diagnostic uncertainty, further imaging with magnetic resonance imaging and CT are important [4]. Faculté de medecine et de pharmacie de Marrakech, University Hospital Mohammed VI, Marrakech, Morocco. This site needs JavaScript to work properly. Click here to Login. [Selective neurotization of the median nerve in young patients with CV-CVIIcomplicated spinal cord injury]. Elbow dislocation associated with both radial head and coronoid fractures, termed the “terrible triad injury” (TTI) by Hotchkiss [1], was notoriously challenging for decades because of the difficulties inherent in treatment and the consistently poor prognosis [2-4]. Consequently, each time a radial head fracture associated or not to an elbow dislocation is diagnosed, an ipsilateral wrist examination is mandatory to diagnose an Essex-Lopresti injury; otherwise, chronic wrist symptoms can develop, such as pain and instability [4]. The unhappy triad is the name of a severe injury involving three crucial parts of your knee joint. The 'terrible triad of the elbow' refers to a combination of elbow dislocation and radial head and coronoid process fracture - it is notoriously difficult to manage although a systematic review found that whilst complications are common, functional outcomes are generally satisfactory . Surgical technique - Treatment strategy of terrible triad of the elbow: Experience in Shanghai 6th People's Hospital. Faculté de Medecine et de Pharmacie de Marrakech. An elbow dislocation associated with a displaced fracture of the radial head and coronoid process almost always renders the elbow unstable, making surgical fixation necessary. The stability was rechecked and upgrade of the stable range of motion (ROM) was assessed, the elbow was now stable from −20° extension to complete flexion. Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. In our case, the testing showed a stable elbow, so we decided not to fix the coronoid fracture furthermore that it was a small anteromedial fragment stage 2 according to the O’Driscoll classification. A study [9] has shown that coronoid fractures do not need to be fixed if there is stability in the ROM after repair of lateral structures. Related Content AUTOPLAY ON. Clin Orthop Relat Res. The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications …

Behr Blue Paint Colors 2020, Gma Teleserye 2021, Northern Wind Chords, Zeebrugge Car Port, Uc Berkeley Tennis Courts,