", "Publishing research articles is the key for future scientific progress. What you’ve sustained is called the terrible triad injury, because you’ve broken your ulnar, radial head and also dislocated your entire elbow.’ A picture of this is below, and while I kinda just shrug my shoulders at it, anyone in the medical field just looks a bit uncomfortable and says ‘ouch’ when they see it, so I … Results of treatment of fracture-dislocations of the elbow. Abstract Fracture-dislocations of the elbow remain among the most difficult injuries to manage. These findings stress the importance of obtaining CT scans after initial reduction to assess the size and type of coronoid fracture. Terrible triad injuries usually necessitate operative treatment but there has been some success with non-operative management in carefully selected patients with minimal displacement of the radial and coronoid fragments [27, 28]. Injury 2013; 44(4): 518-22. Terrible triad of the elbow and the Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome. ", "There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Elbow dislocation associated with both radial head and coronoid fractures, termed the “terrible triad injury” (TTI) by Hotchkiss [1], was notoriously challenging for decades because of the difficulties inherent in treatment and the consistently poor prognosis [2-4]. This is where the MCL is least effective. Surgical treatment of terrible triad injuries carries a high risk of complications with an average reoperation rate of 22%. Lindenhovius AL, Brouwer KM, Doornberg JN, Ring DC, Kloen P. Long-term outcome of operatively treated fracture-dislocations of the olecranon. The “terrible triad of the elbow” is a notorious combination of elbow dislocation and fractures of the coronoid process and radial head that has historically been difficult to manage and had an unsatisfactory prognosis 36-38, almost unavoidably causing long‐standing postoperative pain, elbow instability and a range of complications. Other patterns of injury may exist and case reports reflect the multitude of ways in which forces can disrupt the elbow joint. Non-operative treatment involved mobilization of the elbow through its stable range using a hinged brace for 4-8 weeks. They are an outstanding source of medical and scientific information. The elbow fracture dislocations tend to occur in distinct patterns dependant on the mechanism of injury. Articles are of uniformly high quality and written by the world's leading authorities. The primary static stabilisers of the elbow are the ulnohumeral articulation, the MCL and the LCL [5]. Prolonged immobilization in plaster for longer than 4 weeks is detrimental [18]. These injuries are sustained with varus force to the elbow, causing LCL rupture and compression medially. Terrible triad elbow fracture-dislocation with triceps and flexor-pronator mass avulsion. Epidemiology. Fracture of the anteromedial facet of the coronoid process. For this reason, it has been called the “terrible triad injury” of the elbow [3] Terrible triad injuries can lead to pain, recurrent instability, sti ness, and posttraumatic arthritis if not properly treated [6]. These cases are uncommon, but remind us that elbow fracture dislocations and terrible triad injuries are often high-energy, and patients often have concomitant fractures or soft tissue injuries in the ipsilateral limb that may delay recovery if missed. Garrigues GE, Wray WH III, Lindenhovius AL, Ring DC, Ruch DS. If the elbow is unstable after repair of the coronoid, radiohumeral joint and LCL then the MCL can be repaired. Charles J. Malemud received the Ph.D. from George Washington University in 1973 and completed postdoctoral studies at the State University of New York at Stony Brook in 1977. 2 Pt.2): 267-83. J Am Acad Orthop Surg. Introduction. Chung CH, Wang SJ, Chang YC, Wu SS. In valgus stress, the MCL is stretched and the radiohumeral joint compressed, making these the primary stabilizers. They provide easy access to the latest research on a wide variety of issues. Complex elbow dislocations are injuries with significant risk of long-term disability, which may be made worse with inappropriate treatment due to a missed diagnosis. Non-operative treatment has been shown to be successful in patients with small minimally displaced coronoid fractures [47]. Fracture-dislocation of the elbow functional outcome following treatment with a standardized protocol. Bryce CD, Armstrong AD. A surgical strategy based on O’Driscoll classification and ligament injury. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. Current Treatment Concepts for “Terrible Triad” Injuries of the Elbow. NLM The terrible triad of the elbow is a difficult injury with historically poor outcomes. This site needs JavaScript to work properly. Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). Fracture of the anteromedial facet of the coronoid process. The articles are high standard and cover a wide area. -, Instr Course Lect. Giannicola G, Sacchetti FM, Greco A, Cinotti G, Postacchini F. Management of complex elbow instability. We believe that a dedicated and committed team of editors and reviewers make it possible to ensure the quality of the research papers. Park SM, Lee JS, Jung JY, Kim JY, Song KS. Since 1977, Dr. Malemud has been a member of the faculty at Case Western Reserve University School of Medicine where he is presently Professor of Medicine & Anatomy in the Division of Rheumatic Diseases and Senior Investigator of the Arthritis Research Group. He performed a radial head arthroplasty, collateral ligament repair and "fiberwire stitches were placed in a lasso technique around the coronoid avulsed fracture. Between 5 and 20% are associated with a fracture [1, 2] and this combination may complicate recovery. This perspective, Open access journals are high quality of research published the journal annually widest possible diffusion information. 2 Mathew PK terrible triad elbow injury Athwal GS some surgeons advocate prophylactic decompression of the anteromedial coronoid fragment surgical! All scientific journals primarily occurs in adults `` there are many scientists who can afford. 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