Methods: Eight patients identified with “terrible triad” injury patterns, including posterior elbow dislocation, radial head fracture and coronoid fracture, were available for a … We present 2 such injuries in children, 1 combined with an olecranon fracture, and both with good early clinical outcomes. However, in 1 of the 2 cases, avascular necrosis of the proximal radius was evident on radiographs. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. 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 guess the gap in the bone is where I broke it.                           - Radial head replacement or repair for the terrible triad of the elbow: which procedure is better? The terrible triad of the elbow remains a challenging injury that consists of a dislocation of the elbow with fractures of the radial head and coronoid process of the ulna. - Management of Complex Elbow Dislocations: - dislocation w/ radial head frx - terrible triad - Complications: - valgus instability: - patients will show a variable amount of MCL laxity which correlates with a worse clinical and radiographic result; - to maximize the stress on the medial collateral ligament, the forearm should be placed in full pronation, which                   - repair of the lateral collateral ligament; (see posterolateral instability) Pathology Mechanism - Discussion: - terrible triad: ( RHF + MCL + coronoid process frx) + elbow dislocation. Terrible Triad The combination of posterior elbow dislocation with radial head and coronoid process fractures has been described as the “terrible triad” ( Fig 23 ) because it is associated with extensive ligament damage that could result in chronic instability and severe arthritis if inadequately treated ( 57 ).                          - medial approach: terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation. - it is performed after each critical aspect of pathoanatomy was addressed The terrible triad of the elbow is a severe injury that is very difficult to treat. The terrible triad of the elbow is a severe elbow fracture-dislocation pattern and is so-called because it has poor medium-to-long term outcome. Terrible triad injury of the elbow: how to improve outcomes? .................................................................................................................................................................................................................................................................................................................. Clifford R. Wheeless, III, M.D. The stabilizers of the elbow are disrupted from lateral to … 240 views December 1, 2020 7 ; 20:53. {"url":"/signup-modal-props.json?lang=us\u0026email="}. Sort by: Newest.                                  - Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed? Check for errors and try again. Surgical technique The terrible triad of the elbow is posterior or posterolateral dislocation of the ulnohumeral joint with fractures of the radial head and coronoid process. Courses and events.                   - ref: However, since then, this term and the term "terrible triad" have also been used to describe several other combinations of joint injuries, including the terrible triad of the elbow and shoulder. The results of elbow dislocations with associated radial head and coronoid fractures (the so-called “terrible triad” of the elbow) are often poor as a result of arthrosis, recurrent instability, and/or stiffness from prolonged immobilization. Authors of section Editors. Legend Definition skills and equipment level . Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed? - Functional Outcomes After Fixation of “Terrible Triad” Elbow Fracture Dislocations                                  - in this case, lateral approach affords exposure to the coronoid;          - coronoid process frx: The terrible triad injury of the elbow, dislocation of the ulnohumeral joint with fractures of the coronoid process and radial head, is difficult to treat and has a historically poor outcome. The injury is usually associated with typical soft-tissue … (2008) ISBN:1588905047. Although most reports recommend repair and/or replacement of all coronoid and radial head fractures when possible, a recent cadaveric study demonstrated that … The most common trauma mechanism found within our setting was a fall from a height, in which the impact occurred with the elbow and hand extended. An elbow dislocation associated with a displaced fracture of the radial head and coronoid process almost always renders the elbow unstable, making surgical fixation necessary. Elbow joint Dislocations Orthopedics a b s t r a c t Objective: This study aims at analyzing retrospectively the clinical-functional and radio-graphic results of surgical treatment of the terrible elbow triad, with at least 12 months of postoperative follow-up evaluating elbow function. 2. The terrible triad of the elbow is a severe elbow fracture-dislocation pattern and is so-called because it has poor medium-to-long term outcome. - radial head: The ‘terrible triad’ of the elbow is an elbow dislocation with concomitant fractures of the radial head and coronoid. The terrible triad of the elbow and the Essex-Lopresti are two rare injuries but their association is unique [ 1, 2 ]. The ‘terrible triad’ of the elbow is an elbow dislocation with concomitant fractures of the radial head and coronoid. Specialty. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. With recent developments in pathology, anatomy and biomechanics of the elbow … 4.                          - reference: A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. A simple dislocation of the elbow is a capsuloligamentous injury with no fractures; a complex dislocation has associated bony injuries. FEATURING Valentina Greco, Francesco Caranzano. The terrible triad of the elbow is the association of 1,2: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Data Trace is the publisher of                   - lateral flouro images demonstrate if the elbow remains reduced during this maneuver; Patients with the terrible triad of the elbow, surgically treated in the period from 2004 to 2015 by two orthopedic surgeons, upper limb specialists, were retrospectively evaluated in the orthopedic and traumatology department of an upcountry city of Brazil. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury. The “terrible triad” pattern is so named because the three combined injuries of elbow dislocation, radial head fracture and coronoid fracture significantly increase elbow instability and rate of complications [ 3 - 6 ]. Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad.                                  - Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed?      - Critical time period for recovery of range of motion after surgical treatment of complex elbow instability: Prospective study on 76 patients. Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head.          - in the report by McKee MD, et al., the authors recommend: FEATURING Valentina Greco, Francesco Caranzano. Peter Trafton, Michael Baumgaertner.                  3) coronoid frx repair of the coronoid process frx with one of two techniques                           - LCL is typically avulsed off the humeral attachement; 1OrtopeCASE REPORTDr. Login. J Orthop Surg (Hong Kong). Most commonly due to a fall onto an outstretched hand, not necessarily high-energy, with the arm in semi-flexion and supination 3.                   - Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study, - Post Operative Care:                   - often in cases of coronoid frx, radial head will be comminuted and will be require excision, which allows full exposure of coronoid frx; Careful attention to each destabilizing element of the injury pattern is essential and places high demands on the surgeon's mastery of the anatomic complexity of the elbow. - Discussion: - terrible triad: ( RHF + MCL + coronoid process frx) + elbow dislocation. Garving C, Galas A, Horst K, Pfeifer R, Pape HC. Select Management. Terrible Triad of Elbow 1. 1–6 Difficulty in treating patients with this injury is compounded by the lack of information available regarding techniques, results, and complications. What is an elbow terrible triad? In 2003 McKee and his coworkers described the pattern of lateral soft-tissue injury in a series of patients with elbow dislocations and fracture dislocations … The stabilizers of the elbow are disrupted from lateral to … A terrible triad combines three injuries: dislocation of the elbow, fracture of the radial head, and fracture of the coronoid. Seijas R, Ares-Rodriguez O, Orellana A et-al. Objective 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. (Redirected from Blown knee) The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. The terrible triad of the elbow is a difficult injury with historically poor outcomes.                           - look for posterolateral bare area off of the humeral attachment; Share. Wheeless' Textbook of Orthopaedics. Patients with the terrible triad of the elbow, surgically treated in the period from 2004 to 2015 by two orthopedic surgeons, upper limb specialists, were retrospectively evaluated in the orthopedic and traumatology department of an upcountry city of Brazil.                                  - if the radial head is not excised, the coronoid is approached medially; These injuries make up about 30% of elbow dislocations, and are generally caused by falling onto an outstretched arm. It often evolves with loss of elbow range of motion. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. A complex elbow dislocation with associated radial head and coronoid process fractures was named the terrible triad by Hotchkiss1because of historically poor outcomes. 2009;17 (3): 137-51. “Triad” means three. An extensive search of the recent literature was conducted and identified articles were reviewed. Conclusions: Our review had indicated that patients with terrible triad injuries undergo arthroplasty replacement have better clinical outcomes and fewer post-surgery complications than those received the repair surgery. The results of elbow dislocations with associated radial head and coronoid fractures (the so-called “terrible triad” of the elbow) are often poor as a result of arthrosis, recurrent instability, and/or stiffness from prolonged immobilization. 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