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. Specifically, the question of whether to repair or replace the radial head remains controversial. Dr reports a "Terrible Triad Injury" which is, per the Op Note, Radial head fx, coroniodprocess avulsion fx and collateral ligament disruption. Peter Kloen, David Ring. Journal of Orthopaedic Surgery A diagram outlines the treatment algorithm used for radial head management in the treatment of terrible triad injuries, along with intraoperative assessment of stability with the hanging arm test. See the Instructions for Authors for a complete description of levels of evidence. This objective remains a challenge for surgeons due to the complexity of the lesion.5 Capitellum fractures are uncommon, but their prompt diagnosis and management are crucial due to the severity of the consequent functional impairment resulting from these intra-articular elbow fractures. A photograph demonstrates the hanging arm test. Pike JM, Grewal R, Athwal GS, Faber KJ, King GJ. The injury is characterized by elbow instability and development of arthrosis and joint stiffness. The terrible triad of the elbow is characterized by great potential for joint instability and an unfavorable prognosis.1, 5Surgical treatment is the therapy of choice in the vast majority of cases, with the aims of restoration of the anatomy and early mobility. 2015 Nov;40(11):2297-303. doi: 10.1016/j.jhsa.2015.04.039. The most challenging of these problems is recurrent subluxation or dislocation. During the study period, the radial head generally was internally fixed when there were fewer than four articular fragments; otherwise, it was replaced. BACKGROUND: The terrible triad of the elbow comprises an ulnar coronoid process fracture, a radial head (RH) fracture and posterior dislocation of the elbow. 2014; 472(7):2128-35 (ISSN: 1528-1132) Watters TS treatment of the “terrible triad of the elbow”. O'Donoghue estimated the incidence rate in the traumatic sports knee to be 25%. Patterns of Traumatic Elbow Instability With Fracture . Fracture of the anteromedial facet of the coronoid process with injuries to the anterior and posterior bundles of the ulnar collateral ligament and to the lateral ligaments, consistent with varus posteromedial rotatory instability of the elbow (PMRI). Some of the most common injury classification systems cited in … The terrible triad of the elbow is characterized by great potential for joint instability and an unfavorable prognosis. [Medline] . <>/Font<>/ProcSet[/PDF/Text/ImageB]/XObject<>>>/Rotate 0/TrimBox[0 0 595.27600 841.89001]>> 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. 5.2 3-Dimensional reconstruction CT scan of a right elbow with a terrible triad injury, as viewed (a) laterally and (b) medially The individual components of… 472 (7):2128-35. . The four injuries that will be discussed include Monteggia fracture-dislocation, distal humerus fracture, terrible triad, and transolecranon fracture. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach J Int Med Res . The individual components of the terrible triad can be individually classified to aid in the evaluation of this injury: Fractures of the Radial Head The radial head is an important secondary stabilizer of the elbow to valgus stress and the radiocapitellar joint … Most cases require surgery and a recovery period of six to nine months. %PDF-1.6 %���� Retrospective review identified 39 patients with terrible triad injuries and minimum 18-month complete clinical and radiographic followup (mean, 24 months; range, 18-53 months). Dislocation Injuries Disruption Injuries In the mornings when I stretch, I do feel it stretching out, which is kind of satisfying, as the terrible triad … Terrible triad injuries account for approximately 30% of all elbow dislocations.  |  COVID-19 is an emerging, rapidly evolving situation. Specifically, the question of whether to repair or replace the radial head remains controversial. 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