gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018)

23.10. - 26.10.2018, Berlin

Terrible triad injury of the elbow. A single-centre experience

Meeting Abstract

  • presenting/speaker Senat Krasnici - Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Orthopädie, Unfall- und Wiederherstellungschirurgie, Berlin, Germany
  • Benedict B. Kunz - Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Orthopädie, Unfall- und Wiederherstellungschirurgie, Berlin, Germany
  • Kay Krüger - Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Orthopädie, Unfall- und Wiederherstellungschirurgie, Berlin, Germany
  • Flamur Zendeli - Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Orthopädie, Unfall- und Wiederherstellungschirurgie, Berlin, Germany
  • Wolfgang Ertel - Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Orthopädie, Unfall- und Wiederherstellungschirurgie, Berlin, Germany
  • Isabella Fassola - Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Orthopädie, Unfall- und Wiederherstellungschirurgie, Berlin, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocPT27-1177

doi: 10.3205/18dkou824, urn:nbn:de:0183-18dkou8242

Veröffentlicht: 6. November 2018

© 2018 Krasnici et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: To evaluate the results from the surgical treatment of terrible triad injuries (TTI) of the elbow.

Methods: Between 2014 and 2017, 21 patients (twelve males and nine females) aged on average 53.3 years underwent surgical treatment for terrible triad injuries of the elbow. The fractures of the radial head were classified according to Mason in type I (5 cases), type II (5 cases), and type III (11 cases). The fractures of the coronoid process of the ulna were classified according to Regan and Morrey in type I (7 cases), type II (11 cases), and type III (3 cases). The elbow dislocation was posterior in 85.7% of cases. In 76.2% of cases the injury was associated with an ipsilateral fracture involving the olecranon (5 cases), the lateral epicondyle of the humerus (5 cases), the medial epicondyle of the humerus (1 case), the extra-articular proximal ulna (2 cases). In addition, a trans-scaphoid-perilunate dislocation and a triquetrum fracture were diagnosed (1 case each). The average interval between the trauma and the definitive treatment was 5.0 days (min 1, max 10). Initial treatment after closed reduction of the dislocation was splint immobilization (15 cases, 71.4%) and temporary external fixation (6 cases, 28.6%). The surgical approach was via postero-lateral Kocher approach in 11 cases (52.4%), an antero-lateral approach in 9 cases (42.9%), and posterior approach in 1 case (4.8%). An additional medial approach was used in 6 cases (28.6%), specifically in 5 postero-lateral and in 1 antero-lateral approach. The treatment of the radial head and of the coronoid fracture was in the majority of cases surgical (85.7% and 61.9%, respectively). The LUCL and the MCL were repaired in 38.1% and 28.6% of cases, respectively (suture or anchor). The average follow-up was 16.8 months.

Results and conclusion: Average results were: arc of flexion-extension 96°, flexion 111°, extension loss 27°, arc of prono-supination 126°, pronation 65° and supination 59°. On average, strength (measured with Jamar Dynamometer) was 18 kg (contralateral 22.7), VAS was 1.5, DASH was 14 and MEPS was 90. Two (9.5% of cases) complications occurred: one elbow stiffness and one delayed union of the radial head. Both required surgical revision. Heterotopic ossification was present in 3 cases (14.2% of cases).

The surgical treatment for the terrible triad of the elbow generally provided satisfactory results and overall good functional stability, contrary to what reported in the literature.