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A review. Epub 2010 May 8. Review. Refer displaced fractures for surgery. The terrible triad of the elbow is a difficult injury with historically poor outcomes. Peter Trafton, Michael Baumgaertner. 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. Authors of section Editors. concepts. }, author={J. Pipicelli and S. Chinchalkar and R. Grewal and G. Athwal}, journal={Techniques in hand & … Terrible triad. ) 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. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. Legend Definition skills and equipment level. [MODIFIED CLASSIFICATION AND MANAGEMENT OF TERRIBLE TRIAD OF ELBOW]. 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. Terrible triad injury of the elbow: current . Choose treatment. Initial management of the “terrible triad” should consist of a gentle closed reduction under intravenous sedation or general anesthesia. [ 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. 3: … Terrible triad of the elbow and the Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome. Share. 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. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. Main indications. 2011 Jun;35(6):851-60. J Am Acad Orthop Surg. ABSTRACT. 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} } Improved experience, techniques, and implants have advanced to the point where restoration of elbow stability can be expected. [Article in Chinese] Zhang Y, Liu S, Zhou H, Qin X, Zhang X. Immobilise the elbow in a long arm posterior splint with the elbow in 60-90° flexion, well moulded posteriorly. Main indications. Pre-operatively on the ward • Discuss post -operative rehab ’ Background: Terrible triad injuries of the elbow are complex injuries to treat and we report our outcomes following surgical management. Protection of the ligament repair is essential. 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. 'Terrible triad' is a term used to describe a severe complex dislocation with intra-articular fractures of the radial head and coronoid process. Int Orthop. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. Open all credits. Executive Editors. 2: Mathew PK, Athwal GS, King GJ. Open reduction internal fixation. Int Orthop. A review. In non-displaced fractures, splint for 5-7 days, remove and repeat X-ray to confirm non-displacement. 2009 Mar;17(3):137- 51. Review. 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. protocols. J Am Acad Orthop Surg. concepts. The term “terrible triad of the elbow” describes the combination of a traumatic elbow dislocation, radial head fracture, and associated coronoid fracture. Select Management. DOI: 10.1097/BTH.0b013e31822911fd Corpus ID: 34529086. Management of Terrible Triad Injuries of the Elbow . For terrible triads, or ORIF + ligament reconstruction, please also refer to ligament repair protocols. Epub 2010 May 8. Review. This chapter focuses on the evaluation, treatment options, published outcomes, and complications of terrible triad injuries of the elbow. 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. 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. Management of Terrible Triad Injury of the Elbow and their Functional Outcomes. 1 Tyler Vovos MS, 2 Daniel J Blizzard MD MS, 3 Grant Garrigues MD. Characteristics/Clinical Presentation 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. 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. [3] They more commonly occur in adult men, with a peak incidence during the 4th decade of life. Concurrent ipsilateral injuries to the wrist, interosseous membrane of the forearm, and shoulder have been described. 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 … 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. Terrible triad of the Elbow 1. 2: Mathew PK, Athwal GS, King GJ. Elbow Trauma Rehabilitation Protocol Includes post ORIF, or conservatively managed trauma when active ROM indicated N.B. Management. Trans-olecranon fracture-dislocations are best treated surgically with stable anatomic restoration of the trochlear notch. Terrible triad injury of the elbow: current . The coronoid plays a pivotal role as an anterior buttress, yet the optimal management of the coronoid fracture remains unknown. This injury almost always renders the elbow unstable requiring surgical intervention. Elbow instability adam watts 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. Careful attention to each destabilizing element of the injury pattern is essential and places high demands on the surgeon's mastery of the anatomic… An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. 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. Elbow dislocations are staged depending on the disruption of the following stabilizers: the ulnohumeral articulation, MCL, and LCL. Outcomes after terrible triads of the elbow treated with the current surgical . Strategies for management of a terrible triad. 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. Skill level. 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. PubMed PMID: 19264707. 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. 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. Management of a fracture-dislocation injury of the elbow is difficult and usually associated with a high rate of complications. Outcomes after terrible triads of the elbow treated with the current surgical . Peter Kloen, David Ring. 2011 Jun;35(6):851-60. Equipment. Support the arm with collar and cuffs or a standard arm sling. Terrible triad injuries account for approximately 30% of all elbow dislocations. Skill level. 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. 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]. 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. Rehabilitation considerations in the management of terrible triad injury to the elbow. lea in the coronal plane, hinging on the lateral collateral liga­ ment (Figure 2). Hinged external fixation following ORIF. @article{Pipicelli2011RehabilitationCI, title={Rehabilitation considerations in the management of terrible triad injury to the elbow. 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). Management of elbow stiffness after postoperative treatment of terrible triad elbow injury: maintaining mobility and stability using a combined protocol. The terrible triad is the combination of a posterior dislocation of the elbow, radial head and coronoid process fractures. protocols. Terrible triad injuries consist of a posterior dislocation of the elbow, a coronoid fracture, and a radial head fracture. Materials And Methods: … our knowledge of elbow instability and its management. Definite treatment protocols may improve the clinical results of such complex injuries. Corpus ID: 31597300. 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