Results of terrible triads in the elbow: The advantage of primary restoration of medial structure. 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]. Doornberg JN, Ring DC. Complex elbow dislocations are injuries with significant risk of long-term disability. Treatment within a week has been shown to be preferable to delayed or subacute operation (mean delay 7 weeks) as a better flexion arc is achieved postoperatively [30]. 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. ", "Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets. Keywords: Epub 2013 Jul 23. -, Semin Roentgenol. Therefore the presence of any concomitant fracture to the radius, ulna or humerus around the ipsilateral elbow joint is termed a complex dislocation [1]. Non-operative treatment has been shown to be successful in patients with small minimally displaced coronoid fractures [47]. Traditionally the LCL, MCL, coronoid and radial head were reconstructed, but there is recent evidence to support repairing of the coronoid and MCL only if the elbow is unstable after reconstruction of lateral structures. Can we treat select terrible triad injuries nonoperatively? ", "Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content. Elbow dislocation with intra-articular fracture: The results of operative treatment without repair of the medial collateral ligament. The flexion arc can be increased on a weekly basis, and this can be continued in a hinged brace on removal of the external fixator. Peer-review of articles for the journal, which are in the area of expertise (2 to 3 times per year). J Bone Joint Surg Am 2007; 89(Suppl. Terrible triad injury of the elbow: current concepts. The fixation should be solid enough to allow an early range of movement without instability, and does not need to be anatomically reduced. Clin Orthop Relat Res 2014; 472(7): 2084-91. USA.gov. J Orthop Sci 2010; 15(5): 612-9. Doornberg JN, Ring D. Coronoid fracture patterns. Terrible triad injury of the elbow: current concepts. J Orthop Sci 2004; 9(1): 44-50. The articles are of high quality and broad scope. There is also consensus opinion that dislocations with radial head fracture should be treated with radial head replacement in Mason III injuries or Mason II fractures where the joint cannot be reconstructed [20-22]. Ring D, Doornberg JN. J Orthop Trauma 2008; 22(5): 325-31. Arch Orthop Trauma Surg 2013; 133(12): 1665-8. Anterior dislocation with olecranon fracture has the same treatment aims as other complex dislocations with the added need to restore the extensor mechanism. J Orthop Trauma 2000; 14(5): 354-8. J Bone Joint Surg Am. Shukla DR, Pillai G, McAnany S, Hausman M, Parsons BO. Dr reports a "Terrible Triad Injury" which is, per the Op Note, Radial head fx, coroniodprocess avulsion fx and collateral ligament disruption. Clin Orthop Relat Res 2004; (429): 292-300. terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation ; coronoid fractures involving less than 10% of the coronoid do not confer elbow stability in cadaveric studies and therefore do not require repair The instability worsened with a larger 5mm fragment, with instability in varus and valgus positions. J Shoulder Elbow Surg 2015; 24(1): 74-82. Hildebrand KA, Patterson SD, King GJ. Abstract Fracture-dislocations of the elbow remain among the most difficult injuries to manage. ", "It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. J Bone Joint Surg Br 2006; 88-B(SUPP I 192). This is exactly what Open Access Journals provide and this is the reason why I support this endeavor. The authors declare no conflict of interest, financial or otherwise. Some of the most common injury classification systems cited in … 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. van Riet RP, Morrey BF, O’Driscoll SW. Use of osteochondral bone graft in coronoid fractures. This highlights the need of the surgeon to thoroughly assess the patient with routine examination of structures around the elbow that are not usually associated with complex dislocation. Approximately 60% of complex dislocations are caused by a fall from standing height, but the fracture pattern is not always one of inherent fragility, and considerable force is required to sustain a complex dislocation in normal bone. O’Driscoll SW. Elbow dislocations. ", "Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Egol KA, Immerman I, Paksima N, Tejwani N, Koval KJ. 1): 22-32. ", "Open access journals have become a fundamental tool for students, researchers, patients and the general public. Acta Orthop Traumatol Turc 2014; 48(1): 102-5. J Shoulder Elbow Surg 2014; 23(7): 924-32. Elbow stability is described in static and dynamic states. Ring D. Displaced, unstable fractures of the radial head: Fixation. Subtype II fractures less than 2.5mm in size were stable in flexion/ extension but unstable in varus position. Terrible triad injuries necessitate operative treatment in almost all cases. O’Driscoll SW, Morrey BF, Korinek S, An KN. Unfallchirurg 2015. [ Links ] 3 Morrey BF, Chao EY, Hui FC. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 2011 Dec;15(4):198-208. doi: 10.1097/BTH.0b013e31822911fd. Of these, the MCL is the primary stabilizer in flexion, and its removal will cause instability in all positions except extension [6]. Elbow extension with forearm supination and added valgus stress puts most strain on the ulnohumeral joint, radial head and MCL respectively, causing a posterolateral rotational instability pattern of fracture-dislocation which includes posterior dislocation with a radial head fracture and the terrible triad injury with an added coronoid fracture. This is reflected in two recent reviews of patient data, showing male patients in their fourth or fifth decade [12, 13]. The Open Orthopaedics Journal is an Open Access online journal, which publishes research articles, reviews, letters, case reports and guest-edited single topic issues in all areas of experimental and clinical research and surgery in orthopaedics. Axial loading across the joint in these positions puts most stress on the anterior part of the ulnohumeral joint causing coronoid fracture and dislocation. 4 and 5). ", "The widest possible diffusion of information is critical for the advancement of science. 1962 Jun 1;31:51-6 J Bone Joint Surg Am 2009; 91(6): 1448-58. Injury 2013; 44(4): 518-22. Non surgically managed anteromedial coronoid fractures in posteromedial rotatory instability: three cases with 2 years follow-up. Heckman (Eds.) The creation of the trauma network in the UK has concentrated subspecialists geographically and this will lead to more opportunities for collaborative research in these relatively uncommon but severe injuries. [ 37, terrible triad elbow injury ] be fixed strategy based on the articular surface of the ulna out the! Significant in predicting long term stability [ 46 ] `` Publishing research articles a... Elbow joint contract to enable movement [ 7 ] ( 4 ): 151-9 valgus stress flexion/! 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