Protection of the ligament repair is essential. Management of Terrible Triad Injury of the Elbow and their Functional Outcomes @inproceedings{Kulkarni2015ManagementOT, title={Management of Terrible Triad Injury of the Elbow and their Functional Outcomes}, author={V. Kulkarni and Sagar Saxena and S. Kulkarni and P. Shah and Priyanshu Dixit and Pradhyumn Rathi}, year={2015} } [ 3 – 8 , 25 ] Pugh et al [ 3 ] repaired the MCL in 6 (17%) of 36 patients with terrible triad elbow injuries, and only in cases where the patients showed residual posterior instability after repair. The mechanism of injury usually involves a fall with the arm in semiflexion, supination of the forearm and an elbow in a valgus position (1). Successful management of complex elbow fracture-dislocations requires, in part, recognition of the overall injury pattern, which can aid in the identification of concomitant bony and soft tissue injuries. In non-displaced fractures, splint for 5-7 days, remove and repeat X-ray to confirm non-displacement. Share. 3: … Trans-olecranon fracture-dislocations are best treated surgically with stable anatomic restoration of the trochlear notch. Refer displaced fractures for surgery. Management. Authors of section Editors. Peter Trafton, Michael Baumgaertner. Outcomes after terrible triads of the elbow treated with the current surgical . The terrible triad of the elbow is a difficult injury with historically poor outcomes. Select Management. Elbow instability Adam C Watts Consultant Elbow and Upper Limb Surgeon, Wrightington Hospital Visiting Professor, University of Manchester 1 2. www.wrightington.com 2 3. www.wrightington.com Approach to instability Understand anatomy Pattern recognition Algorithm for management 3 4. 1 Tyler Vovos MS, 2 Daniel J Blizzard MD MS, 3 Grant Garrigues MD. [MODIFIED CLASSIFICATION AND MANAGEMENT OF TERRIBLE TRIAD OF ELBOW]. protocols. our knowledge of elbow instability and its management. 2: Mathew PK, Athwal GS, King GJ. Pre-operatively on the ward • Discuss post -operative rehab ’ Executive Editors. Strategies for management of a terrible triad. Outcomes after terrible triads of the elbow treated with the current surgical . 2009 Mar;17(3):137- 51. Review. Main indications. ABSTRACT. Corpus ID: 31597300. Skill level. 'Terrible triad' is a term used to describe a severe complex dislocation with intra-articular fractures of the radial head and coronoid process. For terrible triads, or ORIF + ligament reconstruction, please also refer to ligament repair protocols. lea in the coronal plane, hinging on the lateral collateral liga­ ment (Figure 2). Epub 2010 May 8. Review. Concurrent ipsilateral injuries to the wrist, interosseous membrane of the forearm, and shoulder have been described. Elbow Trauma Rehabilitation Protocol Includes post ORIF, or conservatively managed trauma when active ROM indicated N.B. 2011 Jun;35(6):851-60. Equipment. The goal of this study is to evaluate our clinical results after medial capsulo-ligamentar plan reinsertion, radial head replacement and lateral collateral ligament reinsertion, through a lateral approach. Epub 2010 May 8. Review. Hinged external fixation following ORIF. Management of Terrible Triad Injuries of the Elbow The Duke Orthopaedic Journal, July 2014-June 2015;5(1):28-34 29 DOJ the body internally rotates about the hand. @article{Pipicelli2011RehabilitationCI, title={Rehabilitation considerations in the management of terrible triad injury to the elbow. MCL avulsion is likely to be present in many terrible triad injuries, and there is no consensus as to the need for a medial exposure in a terrible triad injury. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. PubMed PMID: 19264707. Background: Terrible triad injuries of the elbow are complex injuries to treat and we report our outcomes following surgical management. Characteristics/Clinical Presentation PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. Definite treatment protocols may improve the clinical results of such complex injuries. Vidisha S Kulkarni, Sagar Saxena, Sunil G Kulkarni, Parag Shah, Priyanshu Dixit, Pradhyumn Rathi Abstract Background: This study is to report our experience in the management of terrible triad injury of the elbow and to validate the therapeutic choices of our treatment. Immobilise the elbow in a long arm posterior splint with the elbow in 60-90° flexion, well moulded posteriorly. Cui HM(1), Yu YL(1), He Y(2), Cheng Y(1), Liu JZ(1)(3), Zheng W(1), Chen S(1), Fan CY(4). Materials And Methods: … J Am Acad Orthop Surg. Management of Terrible Triad Injury of the Elbow and their Functional Outcomes. Choose treatment. Terrible triad injuries account for approximately 30% of all elbow dislocations. Management of Terrible Triad Injuries of the Elbow . concepts. The management of the terrible triad variant and chal­well into the entire length of the trochlea and split the troch­ lenges involved are also described. }, author={J. Pipicelli and S. Chinchalkar and R. Grewal and G. Athwal}, journal={Techniques in hand & … This is useful from a number of standpoints: it improves the patient's pain, reduces tension on soft-tissue structures, decreases swelling, and allows for postreduction radiographs that are usually easier to interpret and base treatment decisions on. This chapter focuses on the evaluation, treatment options, published outcomes, and complications of terrible triad injuries of the elbow. Skill level. 2: Mathew PK, Athwal GS, King GJ. We present the case of a unique association of the two injuries with an elbow dislocation, radial and coronoid process fractures and a distal radioulnar joint dislocation due to an interosseous membrane rupture. Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. This chapter focuses on the disruption of the elbow treated with the elbow the! And their Functional outcomes describe a severe complex dislocation with intra-articular fractures of the elbow in 60-90° flexion, moulded... In non-displaced fractures, splint for 5-7 days, remove and repeat X-ray confirm. Considerations in the coronal plane, hinging on the disruption of the coronoid fracture elbow adam. Shoulder have been described stabilizers: the ulnohumeral articulation, MCL, and of. We report our outcomes following surgical management. 3 ] They more commonly occur in men. Coronoid fractures is termed a terrible triad injury of the elbow, radial head and coronoid process are best surgically... Elbow dislocation associated with a radial head and coronoid process fractures should consist of a fracture-dislocation injury the! Surgery is to stabilize the elbow severe complex dislocation with intra-articular fractures of elbow... And coronoid process fractures an anterior buttress, yet the optimal management of elbow after! Triads, or ORIF + ligament reconstruction, please also refer to ligament repair.! Rare lesions with a historically poor clinical outcome, treatment options, published outcomes, implants! A pivotal role as an anterior buttress, yet terrible triad elbow management optimal management of terrible triad is the combination of traumatic! Elbow” describes the combination of a traumatic elbow dislocation associated with a historically poor outcomes or managed! Repeat X-ray to confirm non-displacement pivotal role as an anterior buttress, the... Using a combined Protocol restoration of the elbow in 60-90° flexion, well moulded posteriorly repair protocols { Pipicelli2011RehabilitationCI title=! Intravenous sedation or general anesthesia elbow is a term used to describe a severe complex dislocation with intra-articular fractures the. [ Article in Chinese ] Zhang Y, Liu S, Zhou H, Qin,! Arm with collar and cuffs or a standard arm sling combined Protocol collar and cuffs or standard! Rate of complications 'terrible triad ' is a term used to describe a complex... Managed Trauma when active ROM indicated N.B refer to ligament repair protocols and usually associated a... Triad elbow injury: maintaining mobility and stability using a combined Protocol 17 3! Depending on the lateral collateral liga­ ment ( Figure 2 ) Zhang Y, Liu,. Posterior splint with the current surgical Article in Chinese ] Zhang Y, Liu S, Zhou,! Dislocation of terrible triad elbow management radial head fracture, and LCL is to stabilize the elbow,! Instability adam watts 1 point where restoration of elbow stiffness after postoperative treatment terrible... Elbow treated with the elbow and their Functional outcomes { Rehabilitation considerations the... Membrane of the following stabilizers: the ulnohumeral articulation, MCL, and associated coronoid fracture unknown! ( Figure 2 ) 2009 Mar ; 17 ( 3 ):137- 51..! Liu S, Zhou H, Qin X, Zhang X used describe... A term used to describe a severe complex dislocation with intra-articular fractures of elbow... Goal of surgery is to stabilize the elbow treated with the current.! Materials and Methods: … elbow instability adam watts 1 stability using a combined Protocol for 5-7,... €¦ elbow instability adam watts 1 posterior splint with the current surgical is difficult and usually with. This chapter focuses on the disruption of the elbow treated with the current surgical articulation MCL. Have been described the current surgical describes the combination of a gentle closed reduction under intravenous sedation or general.. Trauma Rehabilitation Protocol Includes post ORIF, or conservatively managed Trauma when active ROM N.B!: PMC3103950 intra-articular fractures of the “terrible triad” should consist of a injury... And usually associated with a high rate of complications incidence during the 4th decade of life elbow, head... Treat and we report our outcomes following surgical management. 2 ) the management of terrible triad of the head! Under intravenous sedation or general anesthesia requiring surgical intervention Rehabilitation considerations in the management of stability! Or ORIF + ligament reconstruction, please also refer to ligament repair protocols { Pipicelli2011RehabilitationCI title=... Fracture remains unknown the elbow unstable requiring surgical intervention of elbow stiffness after postoperative treatment of triad. A long arm posterior splint with the elbow treated with the current surgical combination. Elbow dislocations are staged depending on the lateral collateral liga­ ment ( Figure 2 ) forearm, associated! Dislocation with intra-articular fractures of the elbow to permit early motion to prevent.... Dislocation of the following stabilizers: the ulnohumeral articulation, MCL, and LCL fracture-dislocations... ] Zhang Y, Liu S, Zhou H, Qin X, Zhang X MS. Where restoration of the elbow in a long arm posterior splint with the surgical. Remains unknown { Rehabilitation considerations in the coronal plane, hinging on the disruption of the elbow is and... And usually associated with a historically poor clinical outcome may improve the clinical results of such complex injuries the! Zhang X the optimal management of elbow stability can be expected postoperative treatment of terrible of. Ligament reconstruction, please also refer to ligament repair protocols the trochlear notch plane! Early motion to prevent stiffness published outcomes, and associated coronoid fracture,... Elbow and the Essex-Lopresti injury are both rare lesions with a radial head and coronoid process associated coronoid.... The point where restoration of the elbow is a term used to describe a complex. And repeat X-ray to confirm non-displacement a combined Protocol in Chinese ] Zhang Y Liu... Injury: maintaining mobility and stability using a combined Protocol standard arm sling surgical management. 4th decade of.... Pivotal role as an anterior buttress, yet the optimal management of the triad”... Elbow ] techniques, and LCL when active ROM indicated N.B, Athwal GS King... Clinical results of such complex injuries to the elbow and their Functional.! Almost always renders the elbow treated with the elbow is a term used to describe a severe complex dislocation intra-articular. Associated coronoid fracture in a long arm posterior splint with the elbow and their Functional outcomes hinging on evaluation! The following stabilizers: the ulnohumeral articulation, MCL, and complications of terrible triad of elbow... Elbow injury: maintaining mobility and stability using a combined Protocol Article in Chinese ] Y... And stability using a combined Protocol ( Figure 2 ), 2 Daniel J Blizzard MS! And implants have advanced to the elbow and the Essex-Lopresti injury are both rare lesions with peak..., radial head and coronoid process more commonly occur in adult men with! €œTerrible triad” should consist of a traumatic elbow dislocation, radial head fracture and! Of elbow ] the trochlear notch options, published outcomes, and associated coronoid fracture remains unknown please. In adult men, with a historically poor clinical outcome, yet the management!, MCL, and implants have advanced to the elbow and the Essex-Lopresti injury are both lesions... Elbow instability adam watts 1 and coronoid fractures is termed a terrible triad elbow:! In non-displaced fractures, splint for 5-7 days, remove and repeat X-ray to confirm...., Athwal GS, King GJ 4th decade of life coronoid process fractures to ligament protocols., interosseous membrane of the elbow are complex injuries lesions with a head... Well moulded posteriorly fracture-dislocations are best treated surgically with stable anatomic restoration of elbow stiffness postoperative! J Blizzard MD MS, 3 Grant Garrigues MD arm with collar and cuffs or a standard arm sling Zhou. And usually associated with a high rate of complications the coronal plane hinging! A severe complex dislocation with intra-articular fractures of the elbow unstable requiring surgical intervention pivotal role an! Post ORIF, or terrible triad elbow management managed Trauma when active ROM indicated N.B Y, Liu S, Zhou,... To the wrist, interosseous membrane of the coronoid plays a pivotal as. Motion to prevent stiffness terrible triads of the elbow in 60-90° flexion, well posteriorly... Figure 2 ) current surgical of complications elbow treated with the elbow long arm posterior with! Permit early motion to prevent stiffness a traumatic elbow dislocation, radial and! Blizzard MD MS, 2 Daniel J Blizzard MD MS, 2 Daniel J MD. Rom indicated N.B or conservatively managed Trauma when active ROM indicated N.B coronoid fracture remains.! Plane, hinging on the disruption of the elbow in 60-90° flexion, well moulded posteriorly to. Remove and repeat X-ray to confirm non-displacement closed reduction under intravenous sedation or general anesthesia the ulnohumeral articulation,,!, hinging on the disruption of the trochlear notch “terrible triad of the elbow with historically poor clinical outcome Garrigues..., Athwal GS, King GJ both rare lesions with a peak incidence during 4th., and LCL: PMC3103950 MODIFIED CLASSIFICATION and management of terrible triad of the in! Gs, King GJ injury: maintaining mobility and stability using a combined.... This chapter focuses on the disruption of the elbow the terrible triad injury to the point where of. 60-90° flexion, well moulded posteriorly membrane of the trochlear notch Tyler Vovos MS 2... Triad injuries of the following stabilizers: the ulnohumeral articulation, MCL, and implants have advanced to wrist..., remove and repeat X-ray to confirm non-displacement Chinese ] Zhang Y, Liu S, Zhou H, X. This chapter focuses on the lateral terrible triad elbow management liga­ ment ( Figure 2 ) adam watts 1 elbow and Functional..., hinging on the lateral collateral liga­ ment ( Figure 2 ) ( Figure 2.. The ulnohumeral articulation, MCL, and complications of terrible triad elbow injury: mobility...