Objective To review the injury mechanism and the treatment progress of terrible triad of the elbow, and to analyze the direction of further research. Methods Related literature concerning terrible triad of the elbow was extensively reviewed and comprehensively analyzed. Results The main treatment of terrible triad of the elbow is operation. The ultimate goal of treatment is to reconstruct sufficient stability of the elbow. The treatment includes fixation of the coronoid by suture, screw or plate; fixation of radial head by screw and plate, partial or complete replacement of the radial head; fixation of lateral collateral ligament and the medial collateral ligament by bone suture or anchors and the application of the external fixator. These surgical treatments have their own indications and advantages, most get satisfactory results. Conclusion Generally, surgery is needed to maintain the stability of the elbow for patients of terrible triad elbow. However, medial ligament repair or not, the choice of approach, and mechanism of injury still need further study.
Objective To explore the operative method and effectiveness of talocalcaneal coal ition.Methods Between July 2008 and October 2010, 10 patients with talocalcaneal coal ition were treated, including 2 cases ofcongenital talocalcaneal coal ition and 8 cases of secondary talocalcaneal coal ition. There were 4 males and 6 females, aged53.5 years on average (range, 16-70 years). Three patients had middle-facet talocalcaneal coal ition and 7 had posterior-facettalocalcaneal coal ition. The preoperative visual analogue score (VAS) was 9.0 ± 0.4. According to American OrthopedicFoot and Ankle Society (AOFAS) hindfoot scale, the score was 42.4 ± 1.4. Two cases compl icated by subtalar degeneration.Resection of the bone bar and fat packing were performed in 8 cases of simple talocalcaneal coal ition, and resection and subtalararthrodesis in 2 cases of talocalcaneal coal ition combined with subtalar degeneration. Results Primary healing of incisionswas obtained in all patients. Eight patients were followed up 18 months on average (range, 12-36 months). At last follow-up,VAS was 2.0 ± 0.7, showing siginificant difference when compared with preoperative score (t=6.425, P=0.000). AOFAS score was86.9 ± 2.3, showing significant difference when compared with preoperative score (t=7.634, P=0.000). The X-ray films showedthat no recurrence of talocalcaneal coal ition was observed in patients underdoing simple removal of bone bar, and bone fusionwas observed in patients undergoing arthrodesis. Conclusion To achieve satisfactory outcomes for talocalcaneal coal ition, areasonable surgical procedure should be chosen according to the specific facet and complication.