MODIFIED CLASSIFICATION AND MANAGEMENT OF TERRIBLE TRIAD OF ELBOW_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGYou ¹ ,  LIUShiqing ¹ , ZHOUHongbin ² , QINXiaorong ² , ZHANGXiangwei ²

1. The First Clinical College, the People's Hospital of Wuhan University, Wuhan Hubei, 430060, P.R.China;
2. Department of Orthopaedics, Yiling Hospital;

Corresponding?author：

LIUShiqing, Email: james-1234@126.com

Keywords：

Elbow; Terrible triad injury; Classification criteria

DOI：

10.7507/1002-1892.20160069

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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. Methods Between March 2007 and November 2013, 12 cases of terrible triad of the elbow were treated by operation. There were 5 males and 7 females with an average age of 37.2 years (range, 26-74 years). The mechanism of injury was falling from height in 8 cases and traffic accident in 4 cases. The time from injury to operation was 4 to 11 days (mean, 6.8 days). According to the radial head, coronoid process, olecranon, and medial and lateral collateral ligament complexes injury situation, and based on Mason classification standard and O'Driscoll criteria, the classification standard of terrible triad of the elbow was improved. According to classification results, the approach was determined. The fracture reduction and fixation were performed and soft tissue was repaired. Results Dehiscence of incision occurred in 1 case and was cured after dressing change; primary healing was obtained in the other patients. All the cases were followed up 19-35 months (mean, 21.6 months). The X-ray films showed fracture healing at 10-17 weeks (mean 12.8 weeks). At last follow-up, the mean flexion-extension arc of the elbow was 117.9° (range, 95-135°) and the mean forearm pronation and supination were 77.1° (range, 70-85°) and 62.5° (range, 45-75°). According to Mayo elbow performance score (MEPS), the results were excellent in 4 cases, good in 5 cases, and fair in 3 cases. One patient had valgus deformity of elbow who refused radial head replacement, and 5 cases had heterotopic ossification of the elbow on the X-ray films. Conclusion The modified classification of the terrible triad of the elbow is simple and practical, based on the damage assessment of bony structures (radial head, coronoid process, and olecranon) and the soft tissue (medial and lateral collateral ligament complexes). The modified classification can be used effectively for guiding treatment decisions.

Citation： ZHANGYou, LIUShiqing, ZHOUHongbin, QINXiaorong, ZHANGXiangwei. MODIFIED CLASSIFICATION AND MANAGEMENT OF TERRIBLE TRIAD OF ELBOW. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(3): 353-358. doi: 10.7507/1002-1892.20160069 Copy

1.	Xiao K, Zhang J, Li T, et al. Anatomy, definition, and treatment of the "terrible triad of the elbow" and contemplation of the rationality of this designation. Orthop Surg, 2015, 7(1): 13-18.
2.	Zhang SM, Zhu XZ, Huang YG, et al. Terrible triad injury of the elbow: classification with special reference to medial collateral ligament.外科研究與新技術, 2012, 1(1): 69-75.
3.	Hotchkis RN. Displaced fracture of the radial head: internal fixation or excision? J Am Acad Orthop Surg, 1997, 5(1): 1-10.
4.	O'Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fracture: pearls and pitfalls. Instr Course Lect, 2003, 52: 113-134.
5.	Bohn K, Ipaktchi K, Livermore M, et al. Current treatment concepts for "terrible triad" injuries of the elbow. Orthopaedic, 2014, 37(12): 831-837.
6.	Gon?alves LB, Neto Jde A, Correa Filho MR, et al. Terrible triad of the elbow: influence of radial head treatment. Rev Bras Ortop, 2014, 49(4): 328-333.
7.	翁蔚宗, 蘇佳燦.肘關節恐怖三聯征治療進展.中國矯形外科雜志, 2014, 22(8): 710-714.
8.	Zhang C, Zhong B, Luo CF. Treatment strategy of the terrible triad of the elbow: experience in Shanghai 6th People's Hospital. Injury, 2014, 45(6): 942-948.
9.	趙繼, 夏平光, 蔡賢華, 等.手術治療肘關節恐怖三聯征的臨床療效觀察及體會.中國骨與關節損傷雜志, 2014, 29(9): 901-903.
10.	劉觀燚, 李慶, 王強, 等. "肘關節穩定環"概念和重建原則的提出和臨床意義.中國骨與關節損傷雜志, 2014, 29(11): 1113-1115.
11.	Fitzpatrick MJ, Diltz M, McGarry MH, et al. A new fracture model for "terrible triad" injuries of the elbow: influence of forearm rotation on injury patterns. J Orthop Trauma, 2012, 26(10): 591-596.
12.	Papatheodorou LK, Rubright JH, Heim KA, et al. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Clin Orthop Relat Res, 2014, 472(7): 2084-2091.
13.	張弛, 仲飆, 羅從風, 等.外側入路聯合前內側入路治療肘關節"恐怖三聯征"的手術療效.中華骨科雜志, 2015, 35(4): 320-327.
14.	于連祥, 丁曉琳, 劉慶鵬, 等.影響肘關節恐怖三聯征治療效果的因素分析.中國矯形外科雜志, 2013, 21(12): 1190-1194.
15.	Desloges W, Louati H, Papp SR, et al. Objective analysis of lateral elbow exposure with the extensor digitorum communis split compared with the Kocher interval. J Bone Joint Surg (Am), 2014, 96(5): 387-393.
16.	馬寧, 于濤, 袁鋒.肘關節恐怖三聯征的治療進展.中國修復重建外科雜志, 2013, 27(4): 496-499.
17.	Pai V, Pai V. Use of suture anchors for coronoid fractures in the terrible triad of the elbow. J Orthop Surg, 2009, 17 (1): 31-35.
18.	仲飆, 羅從風, 孫輝, 等.肘關節"恐怖三聯征"的手術治療——改良手術技術及初步結果報道.中國骨與關節損傷雜志, 2015, 25(5): 401-404.

1. Xiao K, Zhang J, Li T, et al. Anatomy, definition, and treatment of the "terrible triad of the elbow" and contemplation of the rationality of this designation. Orthop Surg, 2015, 7(1): 13-18.
2. Zhang SM, Zhu XZ, Huang YG, et al. Terrible triad injury of the elbow: classification with special reference to medial collateral ligament.外科研究與新技術, 2012, 1(1): 69-75.
3. Hotchkis RN. Displaced fracture of the radial head: internal fixation or excision? J Am Acad Orthop Surg, 1997, 5(1): 1-10.
4. O'Driscoll SW, Jupiter JB, Cohen MS, et al. Difficult elbow fracture: pearls and pitfalls. Instr Course Lect, 2003, 52: 113-134.
5. Bohn K, Ipaktchi K, Livermore M, et al. Current treatment concepts for "terrible triad" injuries of the elbow. Orthopaedic, 2014, 37(12): 831-837.
6. Gon?alves LB, Neto Jde A, Correa Filho MR, et al. Terrible triad of the elbow: influence of radial head treatment. Rev Bras Ortop, 2014, 49(4): 328-333.
7. 翁蔚宗, 蘇佳燦.肘關節恐怖三聯征治療進展.中國矯形外科雜志, 2014, 22(8): 710-714.
8. Zhang C, Zhong B, Luo CF. Treatment strategy of the terrible triad of the elbow: experience in Shanghai 6th People's Hospital. Injury, 2014, 45(6): 942-948.
9. 趙繼, 夏平光, 蔡賢華, 等.手術治療肘關節恐怖三聯征的臨床療效觀察及體會.中國骨與關節損傷雜志, 2014, 29(9): 901-903.
10. 劉觀燚, 李慶, 王強, 等. "肘關節穩定環"概念和重建原則的提出和臨床意義.中國骨與關節損傷雜志, 2014, 29(11): 1113-1115.
11. Fitzpatrick MJ, Diltz M, McGarry MH, et al. A new fracture model for "terrible triad" injuries of the elbow: influence of forearm rotation on injury patterns. J Orthop Trauma, 2012, 26(10): 591-596.
12. Papatheodorou LK, Rubright JH, Heim KA, et al. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Clin Orthop Relat Res, 2014, 472(7): 2084-2091.
13. 張弛, 仲飆, 羅從風, 等.外側入路聯合前內側入路治療肘關節"恐怖三聯征"的手術療效.中華骨科雜志, 2015, 35(4): 320-327.
14. 于連祥, 丁曉琳, 劉慶鵬, 等.影響肘關節恐怖三聯征治療效果的因素分析.中國矯形外科雜志, 2013, 21(12): 1190-1194.
15. Desloges W, Louati H, Papp SR, et al. Objective analysis of lateral elbow exposure with the extensor digitorum communis split compared with the Kocher interval. J Bone Joint Surg (Am), 2014, 96(5): 387-393.
16. 馬寧, 于濤, 袁鋒.肘關節恐怖三聯征的治療進展.中國修復重建外科雜志, 2013, 27(4): 496-499.
17. Pai V, Pai V. Use of suture anchors for coronoid fractures in the terrible triad of the elbow. J Orthop Surg, 2009, 17 (1): 31-35.
18. 仲飆, 羅從風, 孫輝, 等.肘關節"恐怖三聯征"的手術治療——改良手術技術及初步結果報道.中國骨與關節損傷雜志, 2015, 25(5): 401-404.

Chinese Journal of Reparative and Reconstructive Surgery

MODIFIED CLASSIFICATION AND MANAGEMENT OF TERRIBLE TRIAD OF ELBOW

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