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Rev Bras Ortop. 2014 Mar 20;49(3):271-8. doi: 10.1016/j.rboe.2014.03.006. eCollection 2014 May-Jun.

Evaluation of the results from surgical treatment of the terrible triad of the elbow.

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1
Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil.

Abstract

in English, Portuguese

OBJECTIVE:

to evaluate the results from surgical treatment of the terrible triad of the elbow (fracture of the radial head, fracture of the coronoid process and elbow dislocation) and its complications.

METHODS:

between August 2002 and August 2010, 15 patients (15 elbows) with the terrible triad were treated by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology, School of Medical Sciences, Santa Casa de São Paulo. Nine (60%) were male and six (40%) were female; their ages ranged from 21 to 66 years, with a mean of 41 years. With the exception of one case that underwent arthroscopic surgery, all the patients underwent open surgery. The fracture of the coronoid process was fixed in 10 patients (66.7%). The fracture of the radial head was treated by means of internal osteosynthesis in 11 cases (73.3%); in three cases (20%), the radial head was resected; and in one case, only the fragment of the fracture was resected. The collateral ligaments, except for one case, were repaired whenever they were found to be injured; ten cases (66.7%) of medial collateral injury and 15 (100%) of lateral collateral injury were found. The mean length of the postoperative follow-up was 62 months, with a minimum of 12 months. The postoperative evaluation was done by means of the Bruce score.

RESULTS:

more than 80% of the patients recovered their functional ranges of motion but, according to the Bruce score, only 26% of the patients achieved results that were considered satisfactory.

CONCLUSION:

despite the unsatisfactory results, the functional ranges of motion and elbow function could be restored.

KEYWORDS:

Elbow/injuries; Elbow/surgery; Internal fracture fixation

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