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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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The effect of the coronoid nonunion on the terrible triad of the elbow

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  • presenting/speaker Lucas Braga Jacques Gonçalves - Hospital Madre Teresa, Belo Horizonte, Brazil
  • Marcella Rodrigues Costa - Hospital Madre Teresa, Belo Horizonte, Brazil

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. DocIFSSH19-738

doi: 10.3205/19ifssh1311, urn:nbn:de:0183-19ifssh13116

Published: February 6, 2020

© 2020 Braga Jacques Gonçalves 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: Lesions involving an elbow dislocation associated to a radial head and a coronoid process fractures are called the terrible triad of the elbow. Historically, this lesion often presents difficulties in it approach and unsatisfactory results such as instability, osteoarthritis and elbow stiffness. This study aims to evaluate the clinical and radiographic results of the surgical treatment of the terrible triad of the elbow and the impact of coronoid nonunion on outcomes.

Methods: There were collected 48 cases of terrible triad of the elbow treated operatively by the same hand surgeon. Seventeen patients were excluded and the final sample had 31 patients that were evaluated for an average of 25 months after surgery (range 13 to 51 months). There were 19 male and 12 female with an mean age of 43 years (± 14.5). In 17 patients the coronoid was fixed using the lasso technique, eight were fixed using screws or k-wires and six were not fixed. The radial head fractures was treated with osteosynthesis (14 patients), arthroplasty of the radial head (12 patients), or resection of a small fracture (5 patients). The lateral ligament complex (LLC) was repaired in all patients and the medial collateral ligament (MCL) was repaired in 5 patients. The patients were then divided in two groups: coronoid healing (C) and coronoid nonunion (CN).

Results and Conclusions: The coronoid healed in 18 patients (group C) and did not in 13 patients (CN group). The final average arc of flexion and extension was 111 o. The average pronation was 69o and supination was 63 o. The mean DASH was 13 and the average MEPI was 85. According to the MEPI, 24 patients (77%) had good or excellent results. There were 30% of failure of coronoid fixation non related to the fixation method. Despite this high rate, the results were not affected by the loss of coronoid fixation. There was no statistically significant difference between the results of patients in whom the coronoid healed and those with nonunion. The coronoid nonunion doesn't affect the final results in patients submitted to surgical treatment of terrible triad of the elbow.