gms | German Medical Science

Objectives: The goal of reconstruction of terrible triad injuries is to restore sufficient elbow stability to allow early mobilization within a stable elbow arc of motion. This study is to investigate the surgical strategies of modified tightrope technique for the fracture of ulnar coronoid process, and its application value and clinical curative effect in the terrible triad of the elbow joint.

Methods: A retrospective study was conducted on 63 patients who had been treated for terrible triad of the elbow joint from January 2015 to January 2020.They were 27 males and 36 females, 26 to 68 years of age(mean,38.6 years). Injury Causes: fall injury in 46 cases, high-falling injury in 9 cases, traffic injury in 8 cases. All the patients underwent surgical treatments, and performed to repair the fracture of ulnar coronoid process, the fracture of radial head, and the lateral collateral ligamentous complex from the deep layer to superficial layer in turn. All the fracture of ulnar coronoid process were treated with loop-plate technique, the fracture of radial head was fixed with tiny-plate, anatomical plate and hollow screws or replaced with the prosthesis, and the lateral collateral ligamentous complex was reconstructed with suture anchor without the surgical repair of the medial collateral ligamentous complex. All the patients were equipped with an adjustable brace postoperatively and performed the early function rehabilitation of elbow joint.

Results and conclusion: 63 patients were followed up for 18 to 24 months .All patients got the healing of bony and ligamentous structures. MEPS score of the last follow-up was 55-100 with the average 85.8: elbow function was excellent in 47 cases, good in 8, fair in 5 and poor in 3, giving an excellent to good rate of 87.3 ％. Elbow stiffness occurred in 3 cases, heterotopic ossification occurred in 4 cases and superficial infection occurred in in 4case who was healed with the treatment of the anti-infection and wound care. No other severe complications like neurovascular injury, loosening or breakage of internal implants, dialocation of elbow joint, fracture nonunion and deep infection occurred. The restoration of the fracture of ulnar coronoid process is the key factor. The loop-plate technique for the fracture of ulnar coronoid process in the treatment for the terrible triad of the elbow can obtain an excellent fixation of coronoid process, restore the elbow joint stability, early functional exercise, and obtain the satisfactory clinical effects.