gms | German Medical Science

Objectives: Elbow fractures dislocations are a rare pathologies with difficult therapeutic management. They result from high energy trauma in young population and low energy in the elderly. We have proposed the description of a lesional association, we have not found described in the literature, which we agree to call the "terrible tetrad". The tetrad consists of olecranon, radial head and coronoid fracture associated with a posterior or posterolateral elbow dislocation. The aim of this work is the description of the terrible tetrad and treatment algorithm in patients and cadaveric models.

Methods: This paper has a evidence level 4, retrospective study. Seven patients who had posterior or posterolateral elbow dislocation associated with coronoid, radial head and olecranon fracture, between 2002 and 2014. Five were women and two men, with an average age of 51 years (range 72-18 years). Five patients had affected they right limb and two on the left. Five injuries were high-energy trauma. Regan and Morrey, Masson and May classifications for coronoid, radial head and olecranon fractures respectively were used. All patients underwent acute closed reduction and immobilization with a cast. In all patients a posterior approach with lateral extension was performed, for better exposure of the radial head. It was made Broberg and Morrey score and DASH questionnaire. We have also replicated the tetrad lession in cadaveric specimens using an anterior approach and implemented our therapeutic algorithm by a posterior approach.

Results: In the Broberg and Morrey score an average functional outcome of 77 points (range 96-38) and in the DASH questionnaire average result of 30 (78 -10) was obtained. Three patients required reoperation. The average range of motion was 96 ° flexion and extension (between 120 ° and 45 °) and supination of 126 ° (150 ° and 40 °) with an average supination of 57 ° (70 to 40 °) and pronation 48.5 ° (60 to -30 °). No intraoperative complications or infections occurred in any of the patients.

Conclusion: The association of olecranon, coronoid and radial head fracture with elbow dislocation is a rare and difficult lesion. The main challenge is the correct preoperative diagnosis. The success of surgery is based on obtaining a stable elbow by a suitable surgical planning, identification of lesions of the articular surfaces reconstruction and repair of ligamentous structures.