MODIFIED CLASSIFICATION AND MANAGEMENT OF TERRIBLE TRIAD OF ELBOW_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGYou ¹ ,  LIUShiqing ¹ , ZHOUHongbin ² , QINXiaorong ² , ZHANGXiangwei ²

1. The First Clinical College, the People's Hospital of Wuhan University, Wuhan Hubei, 430060, P.R.China;
2. Department of Orthopaedics, Yiling Hospital;

Corresponding author：

LIUShiqing, Email: james-1234@126.com

Keywords：

Elbow; Terrible triad injury; Classification criteria

DOI：

10.7507/1002-1892.20160069

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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. Methods Between March 2007 and November 2013, 12 cases of terrible triad of the elbow were treated by operation. There were 5 males and 7 females with an average age of 37.2 years (range, 26-74 years). The mechanism of injury was falling from height in 8 cases and traffic accident in 4 cases. The time from injury to operation was 4 to 11 days (mean, 6.8 days). According to the radial head, coronoid process, olecranon, and medial and lateral collateral ligament complexes injury situation, and based on Mason classification standard and O'Driscoll criteria, the classification standard of terrible triad of the elbow was improved. According to classification results, the approach was determined. The fracture reduction and fixation were performed and soft tissue was repaired. Results Dehiscence of incision occurred in 1 case and was cured after dressing change; primary healing was obtained in the other patients. All the cases were followed up 19-35 months (mean, 21.6 months). The X-ray films showed fracture healing at 10-17 weeks (mean 12.8 weeks). At last follow-up, the mean flexion-extension arc of the elbow was 117.9° (range, 95-135°) and the mean forearm pronation and supination were 77.1° (range, 70-85°) and 62.5° (range, 45-75°). According to Mayo elbow performance score (MEPS), the results were excellent in 4 cases, good in 5 cases, and fair in 3 cases. One patient had valgus deformity of elbow who refused radial head replacement, and 5 cases had heterotopic ossification of the elbow on the X-ray films. Conclusion The modified classification of the terrible triad of the elbow is simple and practical, based on the damage assessment of bony structures (radial head, coronoid process, and olecranon) and the soft tissue (medial and lateral collateral ligament complexes). The modified classification can be used effectively for guiding treatment decisions.

Citation： ZHANGYou, LIUShiqing, ZHOUHongbin, QINXiaorong, ZHANGXiangwei. MODIFIED CLASSIFICATION AND MANAGEMENT OF TERRIBLE TRIAD OF ELBOW. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(3): 353-358. doi: 10.7507/1002-1892.20160069 Copy

1.	Xiao K, Zhang J, Li T, et al. Anatomy, definition, and treatment of the "terrible triad of the elbow" and contemplation of the rationality of this designation. Orthop Surg, 2015, 7(1): 13-18.
2.	Zhang SM, Zhu XZ, Huang YG, et al. Terrible triad injury of the elbow: classification with special reference to medial collateral ligament.外科研究与新技术, 2012, 1(1): 69-75.
3.	Hotchkis RN. Displaced fracture of the radial head: internal fixation or excision? J Am Acad Orthop Surg, 1997, 5(1): 1-10.
4.	O'Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fracture: pearls and pitfalls. Instr Course Lect, 2003, 52: 113-134.
5.	Bohn K, Ipaktchi K, Livermore M, et al. Current treatment concepts for "terrible triad" injuries of the elbow. Orthopaedic, 2014, 37(12): 831-837.
6.	Gonçalves LB, Neto Jde A, Correa Filho MR, et al. Terrible triad of the elbow: influence of radial head treatment. Rev Bras Ortop, 2014, 49(4): 328-333.
7.	翁蔚宗, 苏佳灿.肘关节恐怖三联征治疗进展.中国矫形外科杂志, 2014, 22(8): 710-714.
8.	Zhang C, Zhong B, Luo CF. Treatment strategy of the terrible triad of the elbow: experience in Shanghai 6th People's Hospital. Injury, 2014, 45(6): 942-948.
9.	赵继, 夏平光, 蔡贤华, 等.手术治疗肘关节恐怖三联征的临床疗效观察及体会.中国骨与关节损伤杂志, 2014, 29(9): 901-903.
10.	刘观燚, 李庆, 王强, 等. "肘关节稳定环"概念和重建原则的提出和临床意义.中国骨与关节损伤杂志, 2014, 29(11): 1113-1115.
11.	Fitzpatrick MJ, Diltz M, McGarry MH, et al. A new fracture model for "terrible triad" injuries of the elbow: influence of forearm rotation on injury patterns. J Orthop Trauma, 2012, 26(10): 591-596.
12.	Papatheodorou LK, Rubright JH, Heim KA, et al. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Clin Orthop Relat Res, 2014, 472(7): 2084-2091.
13.	张弛, 仲飙, 罗从风, 等.外侧入路联合前内侧入路治疗肘关节"恐怖三联征"的手术疗效.中华骨科杂志, 2015, 35(4): 320-327.
14.	于连祥, 丁晓琳, 刘庆鹏, 等.影响肘关节恐怖三联征治疗效果的因素分析.中国矫形外科杂志, 2013, 21(12): 1190-1194.
15.	Desloges W, Louati H, Papp SR, et al. Objective analysis of lateral elbow exposure with the extensor digitorum communis split compared with the Kocher interval. J Bone Joint Surg (Am), 2014, 96(5): 387-393.
16.	马宁, 于涛, 袁锋.肘关节恐怖三联征的治疗进展.中国修复重建外科杂志, 2013, 27(4): 496-499.
17.	Pai V, Pai V. Use of suture anchors for coronoid fractures in the terrible triad of the elbow. J Orthop Surg, 2009, 17 (1): 31-35.
18.	仲飙, 罗从风, 孙辉, 等.肘关节"恐怖三联征"的手术治疗——改良手术技术及初步结果报道.中国骨与关节损伤杂志, 2015, 25(5): 401-404.

1. Xiao K, Zhang J, Li T, et al. Anatomy, definition, and treatment of the "terrible triad of the elbow" and contemplation of the rationality of this designation. Orthop Surg, 2015, 7(1): 13-18.
2. Zhang SM, Zhu XZ, Huang YG, et al. Terrible triad injury of the elbow: classification with special reference to medial collateral ligament.外科研究与新技术, 2012, 1(1): 69-75.
3. Hotchkis RN. Displaced fracture of the radial head: internal fixation or excision? J Am Acad Orthop Surg, 1997, 5(1): 1-10.
4. O'Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fracture: pearls and pitfalls. Instr Course Lect, 2003, 52: 113-134.
5. Bohn K, Ipaktchi K, Livermore M, et al. Current treatment concepts for "terrible triad" injuries of the elbow. Orthopaedic, 2014, 37(12): 831-837.
6. Gonçalves LB, Neto Jde A, Correa Filho MR, et al. Terrible triad of the elbow: influence of radial head treatment. Rev Bras Ortop, 2014, 49(4): 328-333.
7. 翁蔚宗, 苏佳灿.肘关节恐怖三联征治疗进展.中国矫形外科杂志, 2014, 22(8): 710-714.
8. Zhang C, Zhong B, Luo CF. Treatment strategy of the terrible triad of the elbow: experience in Shanghai 6th People's Hospital. Injury, 2014, 45(6): 942-948.
9. 赵继, 夏平光, 蔡贤华, 等.手术治疗肘关节恐怖三联征的临床疗效观察及体会.中国骨与关节损伤杂志, 2014, 29(9): 901-903.
10. 刘观燚, 李庆, 王强, 等. "肘关节稳定环"概念和重建原则的提出和临床意义.中国骨与关节损伤杂志, 2014, 29(11): 1113-1115.
11. Fitzpatrick MJ, Diltz M, McGarry MH, et al. A new fracture model for "terrible triad" injuries of the elbow: influence of forearm rotation on injury patterns. J Orthop Trauma, 2012, 26(10): 591-596.
12. Papatheodorou LK, Rubright JH, Heim KA, et al. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Clin Orthop Relat Res, 2014, 472(7): 2084-2091.
13. 张弛, 仲飙, 罗从风, 等.外侧入路联合前内侧入路治疗肘关节"恐怖三联征"的手术疗效.中华骨科杂志, 2015, 35(4): 320-327.
14. 于连祥, 丁晓琳, 刘庆鹏, 等.影响肘关节恐怖三联征治疗效果的因素分析.中国矫形外科杂志, 2013, 21(12): 1190-1194.
15. Desloges W, Louati H, Papp SR, et al. Objective analysis of lateral elbow exposure with the extensor digitorum communis split compared with the Kocher interval. J Bone Joint Surg (Am), 2014, 96(5): 387-393.
16. 马宁, 于涛, 袁锋.肘关节恐怖三联征的治疗进展.中国修复重建外科杂志, 2013, 27(4): 496-499.
17. Pai V, Pai V. Use of suture anchors for coronoid fractures in the terrible triad of the elbow. J Orthop Surg, 2009, 17 (1): 31-35.
18. 仲飙, 罗从风, 孙辉, 等.肘关节"恐怖三联征"的手术治疗——改良手术技术及初步结果报道.中国骨与关节损伤杂志, 2015, 25(5): 401-404.

Chinese Journal of Reparative and Reconstructive Surgery

MODIFIED CLASSIFICATION AND MANAGEMENT OF TERRIBLE TRIAD OF ELBOW

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content