Comparison of two techniques for lateral collateral ligament complex repair in treatment of terrible triad of elbow_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JING Lingyong ¹ , ZHAO Huaguo ² ,  LIU Guanyi ²

1. Medicine School of Ningbo University, Ningbo Zhejiang, 315211, P.R.China;
2. Department of Orthopedics, Ningbo No.6 Hospital, Ningbo Zhejiang, 315040, P.R.China;

Corresponding?author：

LIU Guanyi, Email: 18906628697@163.com

Keywords：

Terrible triad of elbow; lateral collateral ligament complex; coronoid process; radial head

DOI：

10.7507/1002-1892.201908111

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Objective To compare the effectiveness of transosseous tunnel fixation and drilling fixation for repair of lateral collateral ligament complex (LCLC) in treatment of terrible triad of elbow (TTE).Methods A clinical data of 50 patients with TTE between June 2012 and January 2018 were retrospectively analyzed. The LCLC was repaired with transosseous tunnel fixation in 22 patients (transosseous tunnel fixation group) and with drilling fixation in 28 patients (drilling fixation group). There was no significant difference between the two groups (P>0.05) in gender, age, fracture side, time from injury to admission, coronoid process fracture classification, radial head fracture classification, and TTE classification. The operation time, intraoperative blood loss, fracture healing time, and complications of the two groups were recorded. At last follow-up, the Mayo elbow performance system (MEPS) score, range of motion of elbow joint, and Broberg-Morrey classification were recorded.Results The operation of two groups were successfully completed. There was no significant difference in the operation time and intraoperative blood loss between the two group (P>0.05). The follow-up time was (24.43±6.84) months in the transosseous tunnel fixation group and (21.55±6.16) months in the drilling fixation group, and the difference was not significant (t=1.534, P=0.132). X-ray films showed that the coronoid process and radial head fractures in the two groups healed, and there was no significant difference in the healing time (P>0.05). At last follow-up, there was no significant difference in the flexion-extension activity, rotation activity, MEPS score, and Broberg-Morrey grading (P>0.05). During the follow-up, there was no re-dislocation or instability of the elbow joint. The incidence of complication was 28.57% (8/28) in the transosseous tunnel fixation group and 27.27% (6/22) in the drilling fixation group, showing no significant difference (χ²=2.403, P=0.121).Conclusion Both transosseous tunnel fixation and drilling fixation can achieve good results in repair of LCLC for TTE.

Citation： JING Lingyong, ZHAO Huaguo, LIU Guanyi. Comparison of two techniques for lateral collateral ligament complex repair in treatment of terrible triad of elbow. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1550-1554. doi: 10.7507/1002-1892.201908111 Copy

1.	O’Driscoll SW, Morrey BF, Korinek S, et al. Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res, 1992, (280): 186-197.
2.	Chen HW, Liu GD, Wu LJ. Complications of treating terrible triad injury of the elbow: A systematic review. PLoS One, 2014, 9(5): e97476.
3.	Pugh DM, Wild LM, Schemitsch EH, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg (Am), 2004, 86(6): 1122-1130.
4.	劉觀燚, 馬維虎, 周雷杰, 等. 肘關節恐怖三聯征的分型及手術治療. 中華骨科雜志, 2017, 37(21): 1361-1370.
5.	Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg (Am), 1989, 71(9): 1348-1354.
6.	Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg, 2010, 42(172): 123-132.
7.	劉觀燚, 趙華國, 王力冉, 等. 橈骨頭桌面重建內固定術治療橈骨頭粉碎性骨折. 中國骨與關節損傷雜志, 2016, 31(3): 317-318.
8.	Jones KJ, Dodson CC, Osbahr DC, et al. The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes. J Shoulder Elbow Surg, 2012, 21(3): 389-395.
9.	Nestor BJ, O’Driscoll SW, Morrey BF. Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg (Am), 1992, 74(8): 1235-1241.
10.	Garrigues GE, Wray WH, Lindenhovius AL, et al. Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg (Am), 2011, 93(20): 1873-1881.
11.	Morrey BF, Bryan RS, Dobyns JH, et al. Total elbow arthroplasty. A five-year experience at the Mayo Clinic. J Bone Joint Surg (Am), 1981, 63(7): 1050-1063.
12.	Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg (Am), 1986, 68(5): 669-674.
13.	Giannicola G, Polimanti D, Sacchetti FM, et al. Soft tissue constraint injuries in complex elbow instability: prevalence, pathoanatomy, and classification. Orthopedics, 2012, 35(12): e1738-1745.
14.	Rhyou IH. Posterolateral rotatory instability of the elbow joint. Archives of Hand and Microsurgery, 2018, 23(2): 69.
15.	Lin KY, Shen PH, Lee CH, et al. Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow. Injury, 2012, 43(10): 1657-1661.
16.	McKee MD, Schemitsch EH, Sala MJ, et al. The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg, 2003, 12(4): 391-396.
17.	查曄軍, 蔣協遠, 公茂琪, 等. 單一外側切口治療肘關節 “三聯征”. 中華創傷骨科雜志, 2014, 16(9): 744-749.
18.	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.
19.	Mehta JA, Bain GI. Posterolateral rotatory instability of the elbow. J Am Acad Orthop Surg, 2004, 12(6): 405-415.

1. O’Driscoll SW, Morrey BF, Korinek S, et al. Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res, 1992, (280): 186-197.
2. Chen HW, Liu GD, Wu LJ. Complications of treating terrible triad injury of the elbow: A systematic review. PLoS One, 2014, 9(5): e97476.
3. Pugh DM, Wild LM, Schemitsch EH, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg (Am), 2004, 86(6): 1122-1130.
4. 劉觀燚, 馬維虎, 周雷杰, 等. 肘關節恐怖三聯征的分型及手術治療. 中華骨科雜志, 2017, 37(21): 1361-1370.
5. Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg (Am), 1989, 71(9): 1348-1354.
6. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg, 2010, 42(172): 123-132.
7. 劉觀燚, 趙華國, 王力冉, 等. 橈骨頭桌面重建內固定術治療橈骨頭粉碎性骨折. 中國骨與關節損傷雜志, 2016, 31(3): 317-318.
8. Jones KJ, Dodson CC, Osbahr DC, et al. The docking technique for lateral ulnar collateral ligament reconstruction: surgical technique and clinical outcomes. J Shoulder Elbow Surg, 2012, 21(3): 389-395.
9. Nestor BJ, O’Driscoll SW, Morrey BF. Ligamentous reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg (Am), 1992, 74(8): 1235-1241.
10. Garrigues GE, Wray WH, Lindenhovius AL, et al. Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg (Am), 2011, 93(20): 1873-1881.
11. Morrey BF, Bryan RS, Dobyns JH, et al. Total elbow arthroplasty. A five-year experience at the Mayo Clinic. J Bone Joint Surg (Am), 1981, 63(7): 1050-1063.
12. Broberg MA, Morrey BF. Results of delayed excision of the radial head after fracture. J Bone Joint Surg (Am), 1986, 68(5): 669-674.
13. Giannicola G, Polimanti D, Sacchetti FM, et al. Soft tissue constraint injuries in complex elbow instability: prevalence, pathoanatomy, and classification. Orthopedics, 2012, 35(12): e1738-1745.
14. Rhyou IH. Posterolateral rotatory instability of the elbow joint. Archives of Hand and Microsurgery, 2018, 23(2): 69.
15. Lin KY, Shen PH, Lee CH, et al. Functional outcomes of surgical reconstruction for posterolateral rotatory instability of the elbow. Injury, 2012, 43(10): 1657-1661.
16. McKee MD, Schemitsch EH, Sala MJ, et al. The pathoanatomy of lateral ligamentous disruption in complex elbow instability. J Shoulder Elbow Surg, 2003, 12(4): 391-396.
17. 查曄軍, 蔣協遠, 公茂琪, 等. 單一外側切口治療肘關節 “三聯征”. 中華創傷骨科雜志, 2014, 16(9): 744-749.
18. 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.
19. Mehta JA, Bain GI. Posterolateral rotatory instability of the elbow. J Am Acad Orthop Surg, 2004, 12(6): 405-415.

Chinese Journal of Reparative and Reconstructive Surgery

Comparison of two techniques for lateral collateral ligament complex repair in treatment of terrible triad of elbow

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