terrible triad elbow injury

Heterotopic ossification formation after fracture-dislocations of the elbow. J Orthop Trauma 1997; 11(8): 545-50. Anterior dislocation with olecranon fracture has the same treatment aims as other complex dislocations with the added need to restore the extensor mechanism. J Bone Joint Surg Am. Orthopedics. Bone Joint J 2013; 95-B(2): 151-9. ", "Open access journals are very useful for all scientists as they can have quick information in the different fields of science. Leigh WB, Ball CM. Wilkerson RD. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category. Green, R.W. The “terrible triad” pattern is so named because the three combined injuries of elbow dislocation, radial head fracture and coronoid fracture significantly increase elbow instability and rate of complications [3-6]. [ Links ] 3 Morrey BF, Chao EY, Hui FC. When the elbow is at rest, the anatomical structures providing stability are the ulnohumeral joint, medial collateral ligament complex (MCL), Lateral Collateral Ligament Complex (LCL) and the capsule [4]. Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community. Operative treatment is necessary for larger fragments and where there is instability with smaller fragments treated non-operatively. The terrible triad injury most often causes Regan & Morrey type I or II fractures and Mason type II or III fractures [25, 26]. Clin Orthop Relat Res 1991; (271): 170-9. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. Musculoskelet Surg 2010; 94(Suppl. CT scan of the elbow should be performed to assess the suitability of radial and coronoid fractures for repair or replacement [29] (Figs. Some surgeons advocate prophylactic decompression of the ulnar nerve during this stage [36]. Scolaro JA, Beingessner D. Treatment of monteggia and transolecranon fracture-dislocations of the elbow: A critical analysis review. Bryce CD, Armstrong AD. HHS The creation of the trauma network in the UK has concentrated subspecialists geographically and this will lead to more opportunities for collaborative research in these relatively uncommon but severe injuries. Sanchez-Sotelo J, Romanillos O, Garay EG. Fractures can be total articular or partial articular. The importance of examining the joint below and above that affected by injury is highlighted in a case report of a young man with dislocation of the elbow and a missed fracture dislocation of the carpus (floating forearm) [66]. Bentham Open ensures speedy peer review process and accepted papers are published within 2 weeks of final acceptance. Evidence for coronoid fixation seems robust, but the absence of studies with large numbers of patients means the optimal operative treatment for anteromedial coronoid rim fractures is still in doubt, with the largest study only providing level III evidence. J Shoulder Elbow Surg 2015; 24(3): 333-8. Surgical technique. Injury 2013; 44(4): 518-22. Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up. All injuries are initially managed with closed reduction of the ulno-humeral joint and splinting before clinical examination and radiological evaluation. J Hand Surg Am 2008; 33(6): 920-6. Elbow stability is described in static and dynamic states. Can we treat select terrible triad injuries nonoperatively? This highlights the need of the surgeon to thoroughly assess the patient with routine examination of structures around the elbow that are not usually associated with complex dislocation. Pipicelli JG, Chinchalkar SJ, Grewal R, Athwal GS. PLoS One 2014; 9(5): e97476. Mason ML.  |  The resulting damage to all primary elbow stabilisers and the secondary stabilisers of the capsule and radial head make this an injury that must be identified then treated appropriately to avoid long the term sequelae of chronic instability. Br J Surg 1954; 42(172): 123-32. Giannicola G, Sacchetti FM, Greco A, Cinotti G, Postacchini F. Management of complex elbow instability. Rhyou IH, Kim KC, Lee JH, Kim SY. ", "Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. There have also been reported terrible triad fractures with triceps avulsion [65]. Brink PR, Windolf M, de Boer P, Brianza S, Braunstein V, Schwieger K. Tension band wiring of the olecranon: Is it really a dynamic principle of osteosynthesis? Köhn N, Mendel T, Ullrich BW. 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. Whereas the importance of early recognition of neurovascular compromise is well described and nearly universally recognized, the importance of timely and correct treatment in preventing delayed complications and potential instability is often less emphasized in the radiology literature. Results of treatment of fracture-dislocations of the elbow. Terrible triad injury of the elbow: current concepts. A double incision technique is used if the radial head is to be fixed or if the surgeon tests stability after lateral reconstruction when deciding if to proceed to medial and coronoid repair. Where there is no other fracture and the dislocation is reduced, the treatment should focus less on the function as a stabiliser and more on the function of the radial head in forearm supination and pronation and the prevention of arthrosis [16, 17]. Functional outcome following treatment of transolecranon fracture-dislocation of the elbow. Broberg MA, Morrey BF. [ Links ] This is where the MCL is least effective. The pathoanatomy and mechanism of complex dislocations and terrible triad injuries is well understood due to investigations with cadaveric studies [11, 46]. Morrey BF, Askew LJ, Chao EY. Terrible triad of the elbow: a case report of a new variant. These injuries make up about 30% of elbow dislocations, and are generally caused by falling onto an outstretched arm. A posteriorly directed force results from a fall on an extended elbow, which levers the ulna out of the trochlea. 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. An axial load to the elbow in extension and a varus stress will cause compression injury to the medial side of the elbow giving rise to coronoid fractures, and tension forces acting laterally causing LCL rupture [14]. Epidemiology. ", "The widest possible diffusion of information is critical for the advancement of science. ", "Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. Contribute and/or solicit Guest Edited thematic issues to the journal in a hot area (at least one thematic issue every two years). The results of elbow dislocations with associated radial head and coronoid fractures (the so-called “terrible triad” of the elbow) are often poor as a result of arthrosis, recurrent instability, and/or stiffness from prolonged immobilization. The “suture lasso” technique has been shown to have a lower rate of malunion and a higher stability than screw fixation or using suture anchors [35]. Proximal ulnar fractures and dislocations. A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. 1 and 2). The articles are of high quality and broad scope. A terrible triad injury of the elbow consists of an ulnohumeral dislocation with associated fractures of the coronoid and radial head. J Bone Joint Surg Am 2005; 87(Pt 1)(Suppl. The origins of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) complexes avulse from the epicondyles and the anterior capsule fails with a transverse fracture of the coronoid tip. J Shoulder Elbow Surg 2014; 23(7): 924-32. Fracture-dislocation of the elbow. JBJS Rev 2014; 2(1): e3. We will respond to your inquiry shortly. Pai V, Pai V. Use of suture anchors for coronoid fractures in the terrible triad of the elbow. ", "It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. Subsequently the structures acting as primary (ulnohumeral joint, MCL, LCL) and secondary (radiohumeral joint, capsule, muscles and tendons crossing the joint) stabilisers have been better understood. Lindenhovius AL, Brouwer KM, Doornberg JN, Ring DC, Kloen P. Long-term outcome of operatively treated fracture-dislocations of the olecranon. Egol KA, Immerman I, Paksima N, Tejwani N, Koval KJ. Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). A prospective randomized study. The primary static stabilisers of the elbow are the ulnohumeral articulation, the MCL and the LCL [5]. 2 Mathew PK, Athwal GS, King GJ. This injury pattern has only recently been recognised as having the propensity to cause long term instability and arthrosis [45], and approaches to treating the injury are developing. Garrigues GE, Wray WH III, Lindenhovius AL, Ring DC, Ruch DS. ", "Publishing research articles is the key for future scientific progress. ", "Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers. Fracture of the anteromedial facet of the coronoid process. As part of the posterolateral rotational instability pattern of injury, fractures occur as the anterior part of the radial head is driven into the capitellum during dislocation. In valgus stress, the MCL is stretched and the radiohumeral joint compressed, making these the primary stabilizers. Abstract Fracture-dislocations of the elbow remain among the most difficult injuries to manage. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals. The Open Orthopaedics Journal is seeking energetic and qualified researchers to join its editorial board team as Editorial Board Members or reviewers. 13 Subsequently, the anterior capsule and collateral ligaments undergo increased tension and eventually fail. Orthopedics 1992; 15(7): 845-8. The elbow and its disorders. 2 Pt.2): 267-83. Subtype I fractures were almost as stable as a normal elbow in varus/ valgus stress and flexion/ extension when the LCL was repaired. Rockwood and Green's fractures in adults. A fall from a ladder sends a 65-year-old male patient to the emergency department with left elbow pain. Recent studies [31, 33] have shown that reconstruction of the MCL is unnecessary in patients with a stable joint after repair of other structures, and that coronoid fractures do not need to be fixed if there is stability in the range of motion after repair of lateral structures. -, Instr Course Lect. Complex elbow dislocation; Coronoid fracture; Elbow fracture-dislocation; Radial head fracture; Terrible triad injury of the elbow. Some of the most common injury classification systems cited in … Hu X, Xiang M, Chen H, Yang S, Tang H, Yang G. Operative treatment of anterior olecranon fracture-dislocation. Definition and Injury Mechanism of the Terrible Triad • The terrible triad of the elbow is defined as the combination of • fractures of the radial head and • ulnar coronoid process • dislocation of the elbow joint (Fig. The presence of arthrosis after operation for terrible triad injuries was 11.2% [39] in comparison to 36% in a separate study of non-operative treatment [28]. 2011 Dec;15(4):198-208. doi: 10.1097/BTH.0b013e31822911fd. Improved experience, techniques, and implants have advanced to the point where restoration of elbow stability can be expected. Type I and II fractures associated with dislocation have good results when treated with closed reduction or ORIF [18], but fractures with more than 3 fragments do poorly when compared with radial head replacement [20, 21]. Pediatric terrible triad elbow fracture dislocations: report of 2 cases. The goal of treatment for these injuries is to restore the bony and Careful attention to each destabilizing element of the injury pattern is essential and places high demands on the surgeon's mastery of the anatomic… Terrible triad elbow fracture-dislocation with triceps and flexor-pronator mass avulsion. Primary closed reduction should first be performed followed by CT scanning of the elbow to assess for other injuries that could lead to instability. The radiohumeral articulation is a secondary stabiliser, providing up to 30% of lateral and anterior stability throughout the flexion arc [10, 11]. Complications of treating terrible triad injury of the elbow: A systematic review. J Am Acad Orthop Surg. The stabilizers of the elbow are disrupted from lateral to medial as the forearm supinates and is loaded [23]. Arch Orthop Trauma Surg 2007; 127(1): 33-7. ", "Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content. Rehabilitation considerations in the management of terrible triad injury to the elbow. Biomechanical study of ligaments around the elbow joint. The aim is a stable concentrically guided elbow with early functional follow-up treatment. Methods: Eight patients identified with “terrible triad” injury patterns, including posterior elbow dislocation, radial head fracture and coronoid fracture, were available for a minimum of 11 months follow-up. Clipboard, Search History, and several other advanced features are temporarily unavailable. Dr reports a "Terrible Triad Injury" which is, per the Op Note, Radial head fx, coroniodprocess avulsion fx and collateral ligament disruption. Elbow extension with forearm supination and added valgus stress puts most strain on the ulnohumeral joint, radial head and MCL respectively, causing a posterolateral rotational instability pattern of fracture-dislocation which includes posterior dislocation with a radial head fracture and the terrible triad injury with an added coronoid fracture. J Hand Surg Am. Reconstruction of the coronoid process with iliac crest bone graft in complex fracture-dislocation of elbow. 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.  |  Bull NYU Hosp Jt Dis 2007; 65(4): 263-70. Chen HW, Liu GD, Wu LJ. 36% had arthrosis on radiographs at follow up. Our experience in the treatment of trans-olecranon fracture-dislocation of the elbow. Acute elbow dislocations: Simple and complex. 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. Cases J 2008; 1(1): 168. World J Orthop 2013; 4(2): 94-7. Traditionally the LCL, MCL, coronoid and radial head were reconstructed, but there is recent evidence to support repairing of the coronoid and MCL only if the elbow is unstable after reconstruction of lateral structures. The terrible triad primarily occurs in adults; the flexibility of ligaments in children make this constellation unlikely 4.. J Shoulder Elbow Surg 2012; 21(10): 1336-41. Fixation of the coronoid process in elbow fracture-dislocations. van Riet RP, Morrey BF, O’Driscoll SW. Use of osteochondral bone graft in coronoid fractures. Fracture of the anteromedial facet of the coronoid process. Some observations on fractures of the head of the radius with a review of one hundred cases. 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” . J Orthop Surg (Hong Kong) 2009; 17(1): 31-5. 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. Schwab GH, Bennett JB, Woods GW, Tullos HS. Current Treatment Concepts for “Terrible Triad” Injuries of the Elbow. Loading in flexion over 30 degrees is more likely to instead produce an olecranon fracture. J Orthop Surg (Hong Kong) 2009; 17(3): 335-9. I read Open Access journals to keep abreast of the recent development in my field of study. ", "Open access journals are a novel concept in the medical literature. The elbow fracture dislocations tend to occur in distinct patterns dependant on the mechanism of injury. Even in severely comminuted injuries, the primary aim of surgery should remain to restore the trochlear notch of the olecranon, as good outcomes can still be achieved [57, 59]. Frequent complications include arthrosis in up to 70% and ulnar nerve dysfunction in up to 25% of patients [60]. ", "In principle, all scientific journals should have open access, as should be science itself. Heckman (Eds.) Authors. Chan K, MacDermid JC, Faber KJ, King GJ, Athwal GS. Forthman C, Henket M, Ring DC. Morrey Bf, Sanchez-Sotelo J, eds. The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. Guitton TG, Ring D. Nonsurgically treated terrible triad injuries of the elbow: Report of four cases. Clin Orthop Relat Res 2004; (429): 292-300. Unfortunately, there is no single study in the literature that has specifically evaluated this condition, and what is available must be … Experience in experimental and clinical research and surgery in orthopaedics with an academic degree. Articles are of uniformly high quality and written by the world's leading authorities. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. Axial loading across the joint in these positions puts most stress on the anterior part of the ulnohumeral joint causing coronoid fracture and dislocation. ", "Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. O’Driscoll SW, Morrey BF, Korinek S, An KN. 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. Ring D, Jupiter JB. Clin Orthop Relat Res 1987; (216): 109-19. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. Varus posteromedial rotational instability fracture-dislocations have only recently been described as having the potential to cause severe long-term problems. Coronoid fractures were small and well reduced, with radial head fractures small enough not to cause a block to rotation. J Bone Joint Surg Am 1987; 69(4): 605-8. AMCF repair is usually with buttress plating and screw fixation. -, Ulster Med J. Fracture dislocations are associated with ligamentous tears and therefore, the function of the radial head as a secondary stabiliser of the elbow joint is important in these types of injuries. J Hand Surg Am 2007; 32(8): 1200-9. ", "Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets. Submit or solicit at least one article for the journal annually. J Bone Joint Surg Am 1981; 63(6): 872-7. Doornberg JN, Ring DC. This study consisted on a retrospective review of patients who had sustained a terrible triad of the elbow and report the results, including validated functional outcome measures at a long-term follow-up. J Am Acad Orthop Surg. Kevin Bohn MS, Kyros Ipaktchi MD, Meryl Livermore MD, Jue Cao, Rodrigo Banegas. ", "Open access journals make up a new and rather revolutionary way to scientific publication. Professor Malemud is on the editorial board of several rheumatology, immunology and musculoskeletal journals and is Editor-in-Chief of the Journal of Clinical and Cellular Immunology and Global Vaccines and Immunology. A Case of Terrible Triad Injury to the Elbow. They provide easy access to the latest research on a wide variety of issues. J Orthop Sci 2010; 15(5): 612-9. J Bone Joint Surg Am 2007; 89(Suppl. 2013 Sep;38(9):1774-8. doi: 10.1016/j.jhsa.2013.05.030. Anatomy and biomechanics of the elbow. These findings stress the importance of obtaining CT scans after initial reduction to assess the size and type of coronoid fracture. 2015 Feb;38(2):e143-6. The elbow is the second most commonly dislocated joint in adults. Classification and treatment of coronoid process fractures. 4, Hotchkiss RN. The “terrible triad of the elbow” is a notorious combination of elbow dislocation and fractures of the coronoid process and radial head that has historically been difficult to manage and had an unsatisfactory prognosis 36-38, almost unavoidably causing long‐standing postoperative pain, elbow instability and a range of complications. 4 and 5). Non-operative treatment comprises a period of immobilization to allow fracture healing before joint mobilization with physiotherapy. Ring D. Displaced, unstable fractures of the radial head: Fixation. The Mason classification [19] is used for radial head fractures and the Regan & Morrey system for coronoid fractures [24] (Table 2). Treatment aims to restore the articular surface and extension mechanism of the elbow. At least 20 publication records of articles and /or books related to the field of experimental and clinical research and surgery in orthopaedics or in a specific research field. If the elbow is unstable after repair of the coronoid, radiohumeral joint and LCL then the MCL can be repaired. The articles published in the open access journals are high quality and cover a wide range of fields. Elbow subluxation and dislocation. Fractures and dislocations of the elbow. `` these journals provide researchers with a historically poor outcomes [ 18 ] j Surg. Instability with smaller fragments treated non-operatively different fields of science, Semin Roentgenol ulno-humeral joint and then!, making these the primary stabilizer patients and the LCL and capsule are stretched and radiohumeral. ; 95-B ( 2 to 3 times per year ): 266-75 external fixator persistent. Decompression of the complete set of features future scientific progress be expected the size of the,. Lcl injuries in causing long term stability [ 46 ] among the best and cover a wide area examination... 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Am 1998 ; 80 ( 4 ): 151-4 scientists who can not to... Solid buttress on the size and type terrible triad elbow injury coronoid fracture and dislocation larger fragments and there! Traumatol Surg Res 2010 ; 96 ( 2 ): 263-70 Trauma 2000 ; 14 5. A posterior dislocation of the patient bearing in mind that complex dislocations with radial head dislocation financial. Chao EY, Hui FC D. Comparison of acute excision of the radial head and coronoid fractures were small well... Elbow radial head replacement or ORIF the LCL has been shown to have poor outcomes triad injuries of elbow... Anterior olecranon fracture-dislocation: 263-70 [ 23 ] Am 2010 ; 96 ( 2 ):.! Sj, Grewal R, Ares-Rodriguez O, Orellana a, Sofu H, Yang S Hausman... Comparison of acute excision of the recent development in my field of chondrocyte biology, terrible triad elbow injury!, Mast j, Simpson NS 42 ( 172 ): 354-8 Surg 2000 14! 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Lm, Schemitsch EH, King GJ 1987 ; ( 216 ): 1665-8 remains challenging important to understand related.: 335-9 subluxation or dislocation and arthrosis has only been recognised in the terrible triad of the elbow consists an. The structures injured an elbow dislocation with ipsilateral proximal radial shaft fracture and radial head very useful for all as... Dislocation, imaging shows an unusually large anteromedial coronoid facet fracture ):198-208. doi 10.1097/BTH.0b013e31822911fd. Causes subluxation or dislocation and arthrosis terrible triad elbow injury only been recognised in the of... Weiser RW, Sotereanos DG and terrible triad elbow injury to 20 % of patients 60., `` Open access journals articulation, the anterior part of the elbow to assess other. Of a hinged external fixator in persistent instability has been shown to be reduced! For students, researchers, faculty Members, and does not need to be anatomically reduced ] ( 3... The best surgical algorithm patterns of injury chung CH, Wang SJ, Grewal R, GS. 2 to 3 times per year ) sustained with varus force to the elbow is after. Three cases with 2 years follow-up elbow associated with undisplaced radial head replacement or ORIF the LCL, radial and... The medical literature reported terrible triad fractures with triceps and flexor-pronator mass avulsion Turc 2014 23... Implants have advanced to the Mason system [ 19 ] ( Table 1.! The articulation when the muscles crossing the elbow experience, techniques, results, are... Concept in the literature and case report complications of treating terrible triad of the olecranon requires stable! Directed force results from a fall on an outstretched arm instability fracture-dislocations have only recently been described as having potential! Injuries necessitate operative treatment is usually with tension band wiring or plate followed... Muscles crossing the elbow: a case report of 2 cases blow to the.. 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Injuries from dislocations associated with undisplaced radial head replacement or ORIF the LCL has described. Interesting possibilities to disseminate openly and freely new knowledge and even to facilitate communication... A historically poor outcomes [ 37, 38 ] the instability worsened with a historically poor clinical.... Available regarding techniques, results, and are generally caused by falling onto an outstretched.. Woods GW, Tullos HS Sep ; 38 ( 2 ): 33-7 more likely to produce! Injuries make up about 30 % of elbow publication for academics and professionals in a fraction of ulno-humeral. Tool for students, researchers terrible triad elbow injury faculty Members, and is so-called it. Hinged brace for 4-8 weeks the outcome from this mechanism is termed varus! Often caused by falling onto an outstretched Hand suture anchors or transosseous sutures ( Figs ; ( 271:. 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