gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Outcome of terrible triad injury of the elbow: do concomitant fractures make a difference?

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  • Senat Krasnici - Department of Trauma and Reconstructive Surgery, Johanniter Krankenhaus Genthin-Stendal GmbH, Stendal, Germany
  • Kay Krüger - Department of Trauma and Reconstructive Surgery, Johanniter Krankenhaus Genthin-Stendal GmbH, Stendal, Germany
  • Flamur Zendeli - University of Basel, Medical School, Basel, Switzerland
  • Wolfgang Ertel - Department of Orthopedics, Trauma and Reconstructive Surgery, University Charité Medical School, Campus Benjamin Franklin, Berlin, Germany
  • presenting/speaker Isabella Fassola - Plastic, Aesthetic, Hand and Reconstructive Micro Surgery, Klinikum Ernst von Bergmann GmbH, Potsdam, Germany

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1781

doi: 10.3205/19ifssh0089, urn:nbn:de:0183-19ifssh00896

Published: February 6, 2020

© 2020 Krasnici et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Terrible triad injuries (TTI) of the elbow are challenging to treat. Aim of this study was to compare the clinical, functional and radiological results from the treatment of these complex fracture-dislocations with or without associated ipsilateral injuries of the upper extremity.

Methods: Twenty-one patients treated for terrible triad injuries of the elbow were retrospectively reviewed at an average follow-up of eighteen months. Group I (n = 9) included patients with isolated TTI and Group II (n = 12) patients with TTI in addition to fractures of the ipsilateral upper extremity. Initial treatment after closed reduction of the dislocation included splint immobilization or temporary external fixation. Treatment of the radial head and of the coronoid fracture was in the majority of cases surgical while both lateral ulnar and medial collateral ligament were managed mostly conservatively.

Results: Overall results were good, with VAS, DASH and MEPI measuring on average 1.5, 16.9 and 89.8, respectively. A high-energy trauma (p = .023) and the use of an external fixator as initial treatment (p = 0.19) were significantly more correlated to patients in Group II than in Group I. MEPI scores were significantly higher for patients in Group I than in Group II (p = 0.46), although both groups had scores corresponding to good and excellent functional results. No difference was found between the two groups in terms of complication rates or heterotopic ossification.

Conclusion: The presence of associated ipsilateral injuries of the upper extremity in patients suffering from terrible triad injuries of the elbow affects the initial treatment, whereas the overall clinical, functional and radiological results are similar to that of patients with isolated injuries of the elbow.