Terrible triad of the elbow and the Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome. Refer displaced fractures for surgery. ABSTRACT. Luckily, elbow specialists have come up with sound strategies to restore the best possible stability and function to the elbow joint after a terrible triad. An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. Choose treatment. The terrible triad of the elbow is a difficult injury with historically poor outcomes. Management of elbow stiffness after postoperative treatment of terrible triad elbow injury: maintaining mobility and stability using a combined protocol. Definite treatment protocols may improve the clinical results of such complex injuries. 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]. Materials And Methods: … Authors of section Editors. Elbow Trauma Rehabilitation Protocol Includes post ORIF, or conservatively managed trauma when active ROM indicated N.B. our knowledge of elbow instability and its management. Share. This injury almost always renders the elbow unstable requiring surgical intervention. Outcomes after terrible triads of the elbow treated with the current surgical . Management of Terrible Triad Injuries of the Elbow . Terrible triad injuries consist of a posterior dislocation of the elbow, a coronoid fracture, and a radial head fracture. Management of Terrible Triad Injury of the Elbow and their Functional Outcomes @inproceedings{Kulkarni2015ManagementOT, title={Management of Terrible Triad Injury of the Elbow and their Functional Outcomes}, author={V. Kulkarni and Sagar Saxena and S. Kulkarni and P. Shah and Priyanshu Dixit and Pradhyumn Rathi}, year={2015} } The terrible triad is the combination of a posterior dislocation of the elbow, radial head and coronoid process fractures. Int Orthop. Pre-operatively on the ward • Discuss post -operative rehab ’ Management. OBJECTIVE: To investigate the feasibility of modified classification of terrible triad of the elbow and the effectiveness of treatment strategy which was chosen by modified classification results. protocols. Cui HM(1), Yu YL(1), He Y(2), Cheng Y(1), Liu JZ(1)(3), Zheng W(1), Chen S(1), Fan CY(4). Careful attention to each destabilizing element of the injury pattern is essential and places high demands on the surgeon's mastery of the anatomic… In the realm of orthopaedics, the terrible triad of the elbow is infamous, not simply because the prognosis is poor for most patients, but also, maybe to a greater extent, because the unique name of this malady attracts considerable attention and interest in both doctors and patients. @article{Pipicelli2011RehabilitationCI, title={Rehabilitation considerations in the management of terrible triad injury to the elbow. 1 Tyler Vovos MS, 2 Daniel J Blizzard MD MS, 3 Grant Garrigues MD. The “terrible triad injury” of the elbow, as named by Hotchkiss, is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture The main objective in the management of such injuries is to restore the stabilizing bony structures of the elbow to convert a complex dislocation of the elbow joint into a simple one. Terrible triad injuries of the elbow, defined as elbow dislocation with associated fractures to the radial head and coronoid, are associated with stiffness, pain, and loss of motion. DOI: 10.1097/BTH.0b013e31822911fd Corpus ID: 34529086. Select Management. The term “terrible triad of the elbow” describes the combination of a traumatic elbow dislocation, radial head fracture, and associated coronoid fracture. Anatomy, Definition, and Treatment of the “Terrible Triad of the Elbow” and Contemplation of the Rationality of this Designation Ke Xiao, PhD; Jia Zhang, MD; Tao Li, MD; Yu-lei Dong, MD; Xi-sheng Weng, MD Orthopaedic Department of Peking Union Medical College Hospital Chinese Academy of Medical Sciences Peking Union Medical College, Beijing, China A … A review. Peter Kloen, David Ring. Terrible triad injury of the elbow: current . }, author={J. Pipicelli and S. Chinchalkar and R. Grewal and G. Athwal}, journal={Techniques in hand & … PubMed PMID: 19264707. Equipment. We present the case of a unique association of the two injuries with an elbow dislocation, radial and coronoid process fractures and a distal radioulnar joint dislocation due to an interosseous membrane rupture. concepts. 3: … protocols. 2011 Jun;35(6):851-60. Corpus ID: 31597300. Background: Terrible triad injuries of the elbow are complex injuries to treat and we report our outcomes following surgical management. Epub 2010 May 8. Review. concepts. Immobilise the elbow in a long arm posterior splint with the elbow in 60-90° flexion, well moulded posteriorly. Terrible triad of the Elbow 1. The terrible triad of the elbow remains a challenging injury that consists of a dislocation of the elbow with fractures of the radial head and coronoid process of the ulna. In non-displaced fractures, splint for 5-7 days, remove and repeat X-ray to confirm non-displacement. Skill level. [ 3 – 8 , 25 ] Pugh et al [ 3 ] repaired the MCL in 6 (17%) of 36 patients with terrible triad elbow injuries, and only in cases where the patients showed residual posterior instability after repair. Open reduction internal fixation. A review. The goal of this study is to evaluate our clinical results after medial capsulo-ligamentar plan reinsertion, radial head replacement and lateral collateral ligament reinsertion, through a lateral approach. Main indications. Peter Trafton, Michael Baumgaertner. Strategies for management of a terrible triad. The coronoid plays a pivotal role as an anterior buttress, yet the optimal management of the coronoid fracture remains unknown. MCL avulsion is likely to be present in many terrible triad injuries, and there is no consensus as to the need for a medial exposure in a terrible triad injury. 2009 Mar;17(3):137- 51. Review. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. Trans-olecranon fracture-dislocations are best treated surgically with stable anatomic restoration of the trochlear notch. Terrible triad injury of the elbow: current . Terrible triad injuries account for approximately 30% of all elbow dislocations. Int Orthop. 2011 Jun;35(6):851-60. Successful management of complex elbow fracture-dislocations requires, in part, recognition of the overall injury pattern, which can aid in the identification of concomitant bony and soft tissue injuries. Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. Protection of the ligament repair is essential. The management of the terrible triad variant and chal­well into the entire length of the trochlea and split the troch­ lenges involved are also described. Characteristics/Clinical Presentation Legend Definition skills and equipment level. Elbow dislocations are staged depending on the disruption of the following stabilizers: the ulnohumeral articulation, MCL, and LCL. For terrible triads, or ORIF + ligament reconstruction, please also refer to ligament repair protocols. Objective Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. This chapter focuses on the evaluation, treatment options, published outcomes, and complications of terrible triad injuries of the elbow. Terrible triad. Main indications. Improved experience, techniques, and implants have advanced to the point where restoration of elbow stability can be expected. Open all credits. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. 2: Mathew PK, Athwal GS, King GJ. Elbow instability Adam C Watts Consultant Elbow and Upper Limb Surgeon, Wrightington Hospital Visiting Professor, University of Manchester 1 2. www.wrightington.com 2 3. www.wrightington.com Approach to instability Understand anatomy Pattern recognition Algorithm for management 3 4. lea in the coronal plane, hinging on the lateral collateral liga­ ment (Figure 2). 'Terrible triad' is a term used to describe a severe complex dislocation with intra-articular fractures of the radial head and coronoid process. ) Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head. Executive Editors. [3] They more commonly occur in adult men, with a peak incidence during the 4th decade of life. J Am Acad Orthop Surg. Management of Terrible Triad Injuries of the Elbow The Duke Orthopaedic Journal, July 2014-June 2015;5(1):28-34 29 DOJ the body internally rotates about the hand. Concurrent ipsilateral injuries to the wrist, interosseous membrane of the forearm, and shoulder have been described. Initial management of the “terrible triad” should consist of a gentle closed reduction under intravenous sedation or general anesthesia. Outcomes after terrible triads of the elbow treated with the current surgical . [MODIFIED CLASSIFICATION AND MANAGEMENT OF TERRIBLE TRIAD OF ELBOW]. Support the arm with collar and cuffs or a standard arm sling. 2: Mathew PK, Athwal GS, King GJ. Epub 2010 May 8. Review. Elbow instability adam watts 1. Management of a fracture-dislocation injury of the elbow is difficult and usually associated with a high rate of complications. Management of Terrible Triad Injury of the Elbow and their Functional Outcomes. The mechanism of injury usually involves a fall with the arm in semiflexion, supination of the forearm and an elbow in a valgus position (1). Vidisha S Kulkarni, Sagar Saxena, Sunil G Kulkarni, Parag Shah, Priyanshu Dixit, Pradhyumn Rathi Abstract Background: This study is to report our experience in the management of terrible triad injury of the elbow and to validate the therapeutic choices of our treatment. Rehabilitation considerations in the management of terrible triad injury to the elbow. J Am Acad Orthop Surg. This is useful from a number of standpoints: it improves the patient's pain, reduces tension on soft-tissue structures, decreases swelling, and allows for postreduction radiographs that are usually easier to interpret and base treatment decisions on. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. [Article in Chinese] Zhang Y, Liu S, Zhou H, Qin X, Zhang X. Skill level. Hinged external fixation following ORIF. The terrible triad injury of the elbow, dislocation of the ulnohumeral joint with fractures of the coronoid process and radial head, is difficult to treat and has a historically poor outcome. 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