The goal of treatment of terrible triad injuries is to restore the bony and ligamentous restraints of the elbow to provide elbow stability. The terrible triad is an uncommon injury, which includes an elbow posterior dislocation with fractures of the radial head and coronoid process of the ulna. Fracture union and concentric reduction of both the ulnotrochlear and radiocapitellar articulations were achieved in all patients. (1) 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. Bull Emerg Trauma. 4th ed. Authors of section Editors. Keywords: Schematic illustration showing a fracture of the anteromedial facet of the coronoid extending to involve the tip of the coronoid process (fracture fragment indicated by dotted lines). The aims of the present paper were to summarize the anatomic and pathophysiological bases, highlight the crucial importance of the humeroradial column and lateral collateral ligament, and to determine the importance of the coronoid process. (eds) Rockwood and Green’s fractures in adults. It is a complex trauma, associating … 1.2. Radial head replacement might be a more effective treatment approach with good clinical outcomes for patients with a terrible triad of the elbow. 20.1 (a–f) Complex elbow instability (terrible triad). An understanding of the specific anatomy of these structures is paramount to the successful treatment of terrible triad injuries. Preoperative anteroposterior (AP) radiograph (A) and three-dimensional computed tomography (B) images show a Mason type III radial head fracture and an O’Driscoll anteromedial subtype 1 coronoid fracture. Postoperative lateral (C) and AP (D) radiographs show concentric reduction of both the ulnotrochlear and radiocapitellar articulations, with no evidence of elbow instability at the 2-year follow-up.  |  Use of Mother-Child Screws in the Treatment of Coronoid Fractures in Terrible Triad Injury of the Elbow. ORIF of Distal Humerus Fractures 07:51. Fractures and dislocations of the elbow In Rockwood CA, editor; Jr, Green DP, Bucholz RW, Heckman JD, editors. USA.gov. Surgical treatment involved radial head repair or replacement, medial and lateral collateral ligament repair, and coronoid fracture fixation through combined approaches. Photographs of a 46-year-old man who sustained a terrible triad injury of the elbow. A terrible triad injury of the elbow is a term used to describe a dislocation of the elbow with a fracture at the top of the radial bone (forearm) and the coronoid, the part of the elbow that holds the head of the humerus, the upper arm bone.Because of the extent of the injury, the usual treatment is open surgery. Elbow dislocation with an associated radial head and coronoid fracture is a relatively rare injury, commonly referred to as a ‘terrible triad’ injury. 4 and 5). Surgery aims to restore perfect stability by sequential anatomic repair, enabling early mobilization to prevent onset of stiffness. Injury 2014; 45: 942–948. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Intervals: 1.2.1. Finally, we propose a simple algorithm to guide repair. Clipboard, Search History, and several other advanced features are temporarily unavailable. [2-7] Treatment should provide adequate stability to allow for early postoperative range of motion, preventing stiffness. This objective remains a challenge for surgeons due to the complexity of the lesion.5 Elbow; anteromedial facet of coronoid; fracture; terrible triad. Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). Separate medial and lateral incisions; Medial approach will be required if a large, repairable radial head is in the way. Operative treatment: 1. Diagnosis. Prevention of these severe complications requires initial understanding of the lesion mechanism and precise analysis of all lesions. Response to the Letter to Editor Regarding "Lateral Approach and Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis". 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]. Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. The goal of treatment of terrible triad injuries is to restore the bony and ligamentous restraints of the elbow to provide elbow stability. 2017 Apr;29(2):125-137. doi: 10.1007/s00064-017-0489-5. The goal of treatment for terrible triad injuries is restoring the bony anatomy and reconstructing the ligamentous restraints of the elbow to provide enough stability for early elbow … 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 Anatomy, Definition, and Treatment of the “Terrible Triad of the Elbow” and Contemplation of the Rationality of this Designation Introduction. J Bone Joint Surg Am. Liu G, Hu J, Ma W, Li M, Xu R, Pan Z. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach. Among the variety of disease designations, the terrible triad of the elbow looms large and is eye‐catching... Anatomy. Shi Y, Wang GF, Mei K, Zhang J, Yun CJ, Qian C, Sun JY. The radial head fracture was fixed with screws, and the lateral collateral ligament was repaired by transosseous sutures through a lateral approach. Objective To report the results of the surgical treatment of terrible triad injury with anteromedial coronoid fracture through a combined surgical approach. The elbow is the second most commonly dislocated joint in adults and up to 20% of dislocations are associated with a fracture. 2018;85(2):102-108. Photographs of a 56-year-old man who sustained a terrible triad injury of the elbow. 2020 Jul;8(3):207-208. doi: 10.30476/BEAT.2020.86013. 2014 Jul;472(7):2084-91. doi: 10.1007/s11999-014-3471-7. -, Egol KA, Immerman I, Paksima N, et al. In general, aggressive operative treatment of radial head injuries restoring the load bearing capacity of the lateral column is preferred in patients with terrible triad injuries. Clin Orthop Relat Res. - Discussion: - terrible triad: ( RHF + MCL + coronoid process frx) + elbow dislocation. The Elbow Terrible Triad - Surgical Treatment. The goals of surgery include (1) reestablishing the support provided by the radial head, (2) performing a dedicated, secure ligament repair, and (3) fixing the coronoid fracture (if the fractured coronoid piece is small, it may not require fixation). Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach Skin incisions: 1.1.1. Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. 1.2. The combination of elbow dislocation with both radial head and coronoid process fracture is notoriously challenging to treat and, as such, has been termed ‘‘terrible triad’’ injury of the elbow (TTIE) [1]. Select Management. Hotchkiss RN . The mean ± SD arc of flexion-extension was 110.3° ± 26.3° and arc of forearm rotation was 139.5° ± 17.1°. Most repairs can be done from the lateral side. 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