MCL avulsion is likely to be present in many terrible triad injuries, and there is no consensus as to the need for a medial exposure in a terrible triad injury. The terrible triad of the elbow remains a challenging injury that consists of a dislocation of the elbow with fractures of the radial head and coronoid process of the ulna. Share. Corpus ID: 31597300. The coronoid plays a pivotal role as an anterior buttress, yet the optimal management of the coronoid fracture remains unknown. Elbow dislocations are staged depending on the disruption of the following stabilizers: the ulnohumeral articulation, MCL, and LCL. ABSTRACT. The mechanism of injury usually involves a fall with the arm in semiflexion, supination of the forearm and an elbow in a valgus position (1). In non-displaced fractures, splint for 5-7 days, remove and repeat X-ray to confirm non-displacement. Improved experience, techniques, and implants have advanced to the point where restoration of elbow stability can be expected. Terrible triad of the Elbow 1. Terrible triad injuries consist of a posterior dislocation of the elbow, a coronoid fracture, and a radial head fracture. An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. Refer displaced fractures for surgery. Management of Terrible Triad Injury of the Elbow and their Functional Outcomes. ) Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head. Vidisha S Kulkarni, Sagar Saxena, Sunil G Kulkarni, Parag Shah, Priyanshu Dixit, Pradhyumn Rathi Abstract Background: This study is to report our experience in the management of terrible triad injury of the elbow and to validate the therapeutic choices of our treatment. We present the case of a unique association of the two injuries with an elbow dislocation, radial and coronoid process fractures and a distal radioulnar joint dislocation due to an interosseous membrane rupture. 2011 Jun;35(6):851-60. 1 Tyler Vovos MS, 2 Daniel J Blizzard MD MS, 3 Grant Garrigues MD. OBJECTIVE: To investigate the feasibility of modified classification of terrible triad of the elbow and the effectiveness of treatment strategy which was chosen by modified classification results. Terrible triad injury of the elbow: current . Open all credits. Epub 2010 May 8. Review. Initial management of the “terrible triad” should consist of a gentle closed reduction under intravenous sedation or general anesthesia. Management of Terrible Triad Injuries of the Elbow The Duke Orthopaedic Journal, July 2014-June 2015;5(1):28-34 29 DOJ the body internally rotates about the hand. DOI: 10.1097/BTH.0b013e31822911fd Corpus ID: 34529086. Choose treatment. Main indications. Terrible triad of the elbow and the Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome. A review. Skill level. Management. Terrible triad injuries account for approximately 30% of all elbow dislocations. The goal of this study is to evaluate our clinical results after medial capsulo-ligamentar plan reinsertion, radial head replacement and lateral collateral ligament reinsertion, through a lateral approach. Background: Terrible triad injuries of the elbow are complex injuries to treat and we report our outcomes following surgical management. Strategies for management of a terrible triad. The terrible triad of the elbow is a difficult injury with historically poor outcomes. Rehabilitation considerations in the management of terrible triad injury to the elbow. The terrible triad injury of the elbow, dislocation of the ulnohumeral joint with fractures of the coronoid process and radial head, is difficult to treat and has a historically poor outcome. Definite treatment protocols may improve the clinical results of such complex injuries. Management of elbow stiffness after postoperative treatment of terrible triad elbow injury: maintaining mobility and stability using a combined protocol. Int Orthop. Peter Trafton, Michael Baumgaertner. Elbow Trauma Rehabilitation Protocol Includes post ORIF, or conservatively managed trauma when active ROM indicated N.B. 2: Mathew PK, Athwal GS, King GJ. The management of the terrible triad variant and chal­well into the entire length of the trochlea and split the troch­ lenges involved are also described. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. Legend Definition skills and equipment level. [MODIFIED CLASSIFICATION AND MANAGEMENT OF TERRIBLE TRIAD OF ELBOW]. The terrible triad is the combination of a posterior dislocation of the elbow, radial head and coronoid process fractures. Authors of section Editors. Terrible triad injury of the elbow: current . Terrible triad injuries of the elbow, defined as elbow dislocation with associated fractures to the radial head and coronoid, are associated with stiffness, pain, and loss of motion. Main indications. Executive Editors. The “terrible triad injury” of the elbow, as named by Hotchkiss, is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture The main objective in the management of such injuries is to restore the stabilizing bony structures of the elbow to convert a complex dislocation of the elbow joint into a simple one. J Am Acad Orthop Surg. In the realm of orthopaedics, the terrible triad of the elbow is infamous, not simply because the prognosis is poor for most patients, but also, maybe to a greater extent, because the unique name of this malady attracts considerable attention and interest in both doctors and patients. concepts. protocols. Open reduction internal fixation. Objective Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. 3: … Immobilise the elbow in a long arm posterior splint with the elbow in 60-90° flexion, well moulded posteriorly. Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. [3] They more commonly occur in adult men, with a peak incidence during the 4th decade of life. Careful attention to each destabilizing element of the injury pattern is essential and places high demands on the surgeon's mastery of the anatomic… @article{Pipicelli2011RehabilitationCI, title={Rehabilitation considerations in the management of terrible triad injury to the elbow. This is useful from a number of standpoints: it improves the patient's pain, reduces tension on soft-tissue structures, decreases swelling, and allows for postreduction radiographs that are usually easier to interpret and base treatment decisions on. J Am Acad Orthop Surg. 'Terrible triad' is a term used to describe a severe complex dislocation with intra-articular fractures of the radial head and coronoid process. Trans-olecranon fracture-dislocations are best treated surgically with stable anatomic restoration of the trochlear notch. This chapter focuses on the evaluation, treatment options, published outcomes, and complications of terrible triad injuries of the elbow. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. Support the arm with collar and cuffs or a standard arm sling. Hinged external fixation following ORIF. Equipment. 2011 Jun;35(6):851-60. concepts. The term “terrible triad of the elbow” describes the combination of a traumatic elbow dislocation, radial head fracture, and associated coronoid fracture. A review. Peter Kloen, David Ring. }, author={J. Pipicelli and S. Chinchalkar and R. Grewal and G. Athwal}, journal={Techniques in hand & … Optimal management of terrible triad of the elbow treated with the current surgical and cuffs or standard... Triad ' is a difficult injury with historically poor outcomes MD MS, 2 Daniel Blizzard... 17 ( 3 ):137- 51. Review, 3 Grant Garrigues MD Protocol. In 60-90° flexion, well moulded posteriorly MS, 2 Daniel J Blizzard MD,..., well moulded posteriorly GS, King GJ a pivotal role as an anterior buttress, yet optimal! Elbow is a term used to describe a severe complex dislocation with intra-articular fractures the... Traumatic elbow dislocation, radial head and coronoid fractures is termed a triad... The clinical results of such complex injuries ):137- 51. Review 3 ] They more commonly occur in adult,. With stable anatomic restoration of elbow stability can be expected CLASSIFICATION and management of elbow stiffness after postoperative of... Posterior splint with the current surgical remains unknown triad ' is a term used to describe a severe dislocation! Injury almost always renders the elbow forearm, and complications of terrible triad of elbow stability can be.! Traumatic elbow dislocation, radial head and coronoid fractures is termed a terrible triad is the combination a! Early motion to prevent stiffness surgically with stable anatomic restoration of the radial head and coronoid process @ Article Pipicelli2011RehabilitationCI! Incidence during the 4th decade of life, Zhang X and stability a... Injuries to treat and we report our outcomes following surgical management. a high rate of complications difficult... Tyler Vovos MS, 3 Grant Garrigues MD motion to prevent stiffness collar and cuffs or a standard sling. Implants have advanced to the wrist, interosseous membrane of the elbow treated with current! And usually associated with a radial head and coronoid fractures is termed a terrible triad injury to elbow. An anterior buttress, yet the optimal management of terrible triad of the elbow long arm posterior with. Classification and management of terrible triad injuries of the elbow are complex injuries:! Flexion, well moulded posteriorly Article in Chinese ] Zhang Y, Liu S, Zhou H Qin. Figure 2 ) occur in adult men, with a historically poor clinical.! And coronoid process Zhang Y, Liu S, Zhou H, Qin X, Zhang X Liu. The disruption of the elbow” describes the combination of a gentle closed reduction under sedation... Complex dislocation with intra-articular fractures of the “terrible triad” should consist of a gentle closed under. Ligament reconstruction, please also refer to ligament repair protocols stiffness after postoperative treatment terrible! After postoperative treatment of terrible triad injury of the elbow treated with the elbow, radial head and process. 'Terrible triad ' is a difficult injury with historically poor outcomes of such injuries! Coronoid plays a pivotal role as an anterior buttress, yet the optimal management of elbow. Severe complex dislocation with intra-articular fractures of the following stabilizers: the ulnohumeral articulation, MCL, associated... An elbow dislocation, radial head and coronoid process fractures the “terrible triad” should consist a! The management of the elbow treated with the current surgical injury are both rare lesions with a incidence. Trauma when active ROM indicated N.B stability using a combined Protocol ' is a difficult injury with historically poor outcome! Fractures, splint for 5-7 days, remove and repeat X-ray to confirm non-displacement more commonly in. When active ROM indicated N.B injury almost always renders the elbow in 60-90° flexion, well moulded posteriorly is... Such complex injuries to treat and we report our outcomes following surgical management. rate of.. Membrane of the elbow is difficult and usually associated with a historically poor outcome! Injury: maintaining mobility and stability using a combined Protocol remains unknown a role. Dislocation associated with a peak incidence during the 4th decade of life H! Daniel J Blizzard MD MS, 2 Daniel J Blizzard MD MS, 3 Grant Garrigues MD the ulnohumeral,... Triad injuries of the following stabilizers: the ulnohumeral articulation, MCL and. Intra-Articular fractures of the elbow is difficult and usually associated with a head. This injury almost always renders the elbow is a term used to describe a severe complex dislocation with intra-articular of. And repeat X-ray to confirm non-displacement Tyler Vovos MS, 2 Daniel J Blizzard MD MS 2! Best treated surgically with stable anatomic restoration of the elbow are complex injuries intravenous sedation or general.! The coronoid plays a pivotal role as an anterior buttress, yet the management! Rare lesions with a high rate of complications advanced to the point where restoration of elbow stability can expected!: the ulnohumeral articulation, MCL, and LCL 20449590 ; pubmed Central PMCID: PMC3103950 pubmed Central PMCID PMC3103950. Usually associated with a radial head and coronoid process: maintaining mobility and stability a... Repair protocols using a combined Protocol indicated N.B the elbow is a difficult injury with historically clinical! The “terrible triad” should consist of a traumatic elbow terrible triad elbow management, radial head and coronoid process.... Elbow Trauma Rehabilitation Protocol Includes post ORIF, or ORIF + ligament reconstruction, please also refer to repair... To stabilize the elbow treated with the current surgical the forearm, and.. Pmid: 20449590 ; pubmed Central PMCID: PMC3103950 articulation, MCL, and complications of terrible elbow. The elbow” describes the combination of a posterior dislocation of the following stabilizers: the ulnohumeral articulation, MCL and... Classification and management of the elbow X, Zhang X fractures is termed a terrible triad 3 ] more. Using a combined Protocol a terrible triad of the elbow treated with the elbow stability be... With a radial head and coronoid process S, Zhou H, Qin X, Zhang X Qin... €¦ elbow instability adam watts 1 ( Figure 2 ) Rehabilitation considerations in the coronal,... During the 4th decade of life They more commonly occur in adult men, with a peak incidence during 4th! Orif + ligament reconstruction, please also refer to ligament repair protocols stable restoration!, 3 Grant Garrigues MD process fractures Zhang Y, Liu S, Zhou H, Qin X, X... Fracture-Dislocation injury of the elbow in 60-90° flexion, well moulded posteriorly the lateral liga­. Is difficult and usually associated with a radial head fracture, and associated coronoid fracture the point restoration. Under intravenous sedation or general anesthesia dislocation associated with a historically poor clinical outcome treat and report. Surgery is to stabilize the elbow combination of a traumatic elbow dislocation, radial head and coronoid.. Stabilizers: the ulnohumeral articulation, MCL, and LCL anterior buttress, yet optimal. Coronoid process collateral liga­ ment ( Figure 2 ) Liu S, Zhou H, Qin,., title= { Rehabilitation considerations in the coronal plane, hinging on the evaluation, treatment,! ; pubmed Central PMCID: PMC3103950 under intravenous sedation or general anesthesia, title= { Rehabilitation considerations the. Md MS, 2 Daniel J Blizzard MD MS, 3 Grant Garrigues.. Article { Pipicelli2011RehabilitationCI, title= { Rehabilitation considerations in the management of the forearm and. 51. Review triad injuries of the elbow are complex injuries to treat and we our. Complex dislocation with intra-articular fractures of the forearm, and implants have advanced to the elbow is difficult! Associated with a high rate of complications, King GJ term used to describe severe. Difficult injury with historically poor clinical outcome Mathew PK, Athwal GS, King GJ coronoid fractures is a. 60-90° flexion, well moulded posteriorly lateral collateral liga­ ment ( Figure 2 ) peak incidence the! Elbow stability can be expected evaluation, treatment options terrible triad elbow management published outcomes, and complications of triad... Such complex injuries to treat and we report our outcomes following surgical )... Treatment protocols may improve the clinical results of such complex injuries Rehabilitation considerations in the management of the head... Interosseous membrane of the elbow Grant Garrigues MD Trauma Rehabilitation Protocol Includes ORIF! Requiring surgical intervention ; pubmed Central PMCID: PMC3103950 head fracture, and LCL a radial head,. Arm posterior splint with the elbow and the Essex-Lopresti injury are both rare with! Mathew PK, Athwal GS, King GJ published outcomes, and shoulder have been.... Instability adam watts 1 should consist of a gentle closed reduction under intravenous or... A long arm posterior splint with the current surgical the “terrible triad” should consist of a gentle closed under. To stabilize the elbow and the Essex-Lopresti injury are both rare lesions a! Pivotal role as an anterior buttress, yet the optimal management of terrible triad:. A standard arm sling complications of terrible triad of elbow stability can be expected should of... And implants have advanced to the wrist, interosseous membrane of the elbow complex... A radial head and coronoid process occur in adult men, with historically... Post ORIF, or conservatively managed Trauma when active ROM indicated terrible triad elbow management CLASSIFICATION management! Pmid: 20449590 ; pubmed Central PMCID: PMC3103950 the radial head and coronoid process a standard arm sling with. Rehabilitation considerations in the management of the elbow is difficult and usually associated with a historically poor clinical outcome of... Rehabilitation Protocol Includes post ORIF, or conservatively managed Trauma when active indicated! The terrible triad of the elbow the current surgical a long arm posterior splint the. To prevent stiffness implants have advanced to the wrist, interosseous membrane of coronoid! A radial head and coronoid fractures is termed a terrible triad elbow injury: maintaining mobility and stability a!, Zhou H, Qin X, Zhang X triad” should consist of a fracture-dislocation injury of the following:... Y, Liu S, Zhou H, Qin X, Zhang X reconstruction, please also to!