Download PDF
CC BY-NC-ND 4.0 · Journal of Health and Allied Sciences NU 2014; 04(03): 127-130
DOI: 10.1055/s-0040-1703820
Case Report

OUR EXPERINCE OF A CASE OF TERRIBLE TRIAD OF ELBOW

Siddharth M. Shetty
1   Associate Professors, Department of Orthopaedic Surgery, K.S. Hegde Medical Academy, Nitte University, Mangalore - 575 018, Karnataka, India.
,
Vikram Shetty
2   Associate Professors, Department of Orthopaedic Surgery, K.S. Hegde Medical Academy, Nitte University, Mangalore - 575 018, Karnataka, India.
,
Arjun Ballal
3   P.G. Students, Department of Orthopaedic Surgery, K.S. Hegde Medical Academy, Nitte University, Mangalore - 575 018, Karnataka, India.
,
Anoop Hegde
4   P.G. Students, Department of Orthopaedic Surgery, K.S. Hegde Medical Academy, Nitte University, Mangalore - 575 018, Karnataka, India.
› Author Affiliations
› Further Information
  PDF Download Permissions and Reprints

Abstract

Dislocation of the elbow joint in association with fracture of radial head and fracture of coronoid process, is referred to as “terrible triad” of the elbow, the treatment of which provides a challenge to treating surgeon due to its complicated outcomes. The understanding of the elbow kinematics, the usage of various implants and surgical techniques in the recent years has led to the development of standard treatment protocols. The 'terrible triad' of the elbow is a severe injury that is difficult to treat and has a poor prognosis in the medium-tolong term. It is characterised most often by instability of the elbow, development of arthrosis and joint stiffness.

A 43 year old lady presented to us after a fall on outstretched dominant hand with severe pain and swelling around elbow. She had sustained a fracture of the radial neck and coronoid process with posterolateral dislocation of elbow. Immediate Closed reduction of the dislocation was performed under GA and elbow was immobilised in a plaster of paris slab for 3 weeks. She underwent operative procedure of open reduction and internal fixation of the radial head with a titanium plate and the coronoid process with a 4mm screw and washer after 10 days.After 3 weeks elbow rehabilitation was begun and at one year post surgery there was signs of fracture healing with full range of motion of the elbow.

Keywords

Terrible triad of elbow - humeroulnar dislocation - radial head fracture - coronoid fracture


Publication History

Article published online:
26 April 2020

© .

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Juan Rodriguez-Martin,Juan Pretell-Mazzini, Eva Maria Andres- Esteban, and RicardoLarrainzar-Garijo. Outcomes after terrible triads of the elbow treated with the current surgical protocols. A review.IntOrthop. 2011 June; 35(6): 851–860.
  • 2 Hotchkiss RN. Fractures and dislocations of the elbow. In: Rockwood CA, Jr, Green DP, Bucholz RW, Heckman JD, editors. Rockwood and Green's fractures in adults.Vol I, 4th ed. Philadelphia: Lippincott- Raven; 1996:929-1024.
  • 3 Lill H, Korner J, Rose T, Hepp P, Verheyden, P, Josten C. Fracturedislocations of the elbow joint—strategy for treatment and results. Arch Orthop Trauma Surg 2001;121:31–7.
  • 4 Pugh DM, McKee MD. The “terrible triad” of the elbow. Tech Hand Up ExtremSurg 2002;6:21–9.
  • 5 S.W. O'Driscoll, J.B. Jupiter, G.J.W. King, R.N. Hotchkiss, B.F. Morrey The unstable elbow J Bone Joint Surg Am, 82 (2000), pp. 724–738
  • 6 S.W. O'Driscoll, B.F. Morrey, S. Korinek, A.D. Kai-Nan. Elbow subluxation and dislocation. A spectrum of instability.ClinOrthop, 280 (1992), pp. 186–197
  • 7 A.D. Amstrong. The terrible triad injury of the elbow.CurrOpinOrthop, 16 (2005), pp. 267–270
  • 8 M.D. McKee, D.M.W. Pugh, L.M. Wild, E.H. Schemitsch, G.J.W. King. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Surgical technique.J Bone Joint Surg Am, 87 (suppl. 1, part 1) (2005), pp. 22–32
  • 9 D. Ring, J.B. Jupiter, J. Zilberfarb. Posterior dislocation of the elbow with fractures of the radial head and coronoid.J Bone Joint Surg Am, 84 (2002), pp. 547–551
  • 10 Bousselmame N, Boussouga M, Bouabid S, Galuia F, Taobane H, Moulay I. Fractures of the coronoid process. Chir Main 2000;19:286–93
  • 11 Roberto Seijas, Oscar Ares-Rodriguez, Adolfo Orellana, Daniel Albareda, Diego Collado, ManelLlusa. Terrible triad of the elbow.Journal of Orthopaedic Surgery 2009;17(3):335-9
  • 12 B. Chemama, N. Bonnevialle, O. Peter, P. MansatCorresponding author contact information, E-mail the corresponding author, P. Bonnevialle. Ter r ible t r iad injury of the elbow: How to improve outcomes?Orthopaedics & Traumatology: Surgery & Research Volume 96, Issue 2, April 2010, Pages 147–154