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Rev Bras Ortop. 2014 Jul 11;49(4):328-33. doi: 10.1016/j.rboe.2014.07.001. eCollection 2014 Jul-Aug.

Terrible triad of the elbow: influence of radial head treatment.

Author information

1
Serviço de Ombro e Cotovelo, Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
2
Serviço de Ortopedia, Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
3
Serviço de Ortopedia e Medicina do Esporte, Hospital Unimed, Belo Horizonte, MG, Brazil.

Abstract

in English, Portuguese

OBJECTIVE:

to test the null hypothesis that patients with the terrible triad of the elbow (dislocation together with fractures of the radial head and coronoid process) who are treated with open reduction and internal fixation of the radial head have final results that are comparable with those of patients treated with arthroplasty or partial resection of the radial head.

METHODS:

twenty-six patients with the terrible triad of the elbow who were operated by a single surgeon were evaluated on average 23 months after the surgery (range: 16-36 months). There were 17 men and nine women of mean age 41 ± 13.4 years. The fractures of the radial head were treated by means of osteosynthesis (12 patients), arthroplasty (nine) or resection of a small fragment or no treatment (five). Fixation of the coronoid process/anterior capsule was performed in 21 patients. The lateral ligament complex (LLC) was repaired in all the patients, while the medial ligament complex (MLC) was repaired in three patients whose elbows remained unstable after treatment for the radial head and LLC, but without fixation of the coronoid process.

RESULTS:

the mean final range of flexion and extension was 112°. The mean pronation was 70° and supination, 6°. The mean DASH score (Disabilities of the Arm, Shoulder & Hand) was 12 and mean MEPI (Mayo Elbow Performance Index) was 87. According to the MEPI scores, 21 patients (80%) had good and excellent results. There was no statistically significant difference in the results between the patients who underwent fixation of the radial head and those who underwent arthroplasty or resection of a small fragment.

CONCLUSION:

there was no difference between the patients treated with arthroplasty of the radial head and those treated with other techniques.

KEYWORDS:

Dislocations; Elbow joint; Radial fractures

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