Effectiveness of lateral approach combined with anteromedial approach for the treatment of terrible triad of the elbow injuries / 中华骨科杂志

ABSTRACT

Objective To investigate the outcomes of lateral approach combined with anteromedial approach for the treatment of terrible triad of the elbow injuries.Methods Data of 23 patients with terrible triad of the elbow injuries treated at our hospital using this modified surgical technique from July 2008 to January 2011 were retrospectively analyzed.Two patients lost to follow-up leaving 21 patients (21 elbows) for evaluation.There were 17 males and 4 females with a mean age of 38.4 years (range,17-63 years).The 21 elbows were treated surgically after a mean of 4 days from the injury.According to O'Driscoll classification of coronoid fractures,there were 5 cases of type A1,12 of A2,and 4 of B2.According to Mason classification of radial head fracture,there were 2 cases of type Ⅰ,12 of Ⅱ,and 7 of Ⅲ.According to Zhong Biao classification of soft tissue injury in terrible triad of the elbow,there were 6 cases of type Ⅰ,12 of Ⅱ,and 3 of Ⅲ.Our surgical procedure included fixation or replacement of the radial head and repair of the ruptured lateral collateral ligament (LCL) through a lateral approach.Simultaneous fixation of the coronoid process and repair of the common flexor muscle and medial collateral ligament (MCL) injury were performed through an anteromedial approach.Mayo elbow performance score (MEPS) was determined for each patient at the latest clinic visit.The Broberg and Morrey classification was used for evaluating traumatic arthritis.Results The mean follow-up period was 32 months.At the latest follow-up the mean flexion-extension arc of the elbow was 126° (range,115°-135°) and the mean forearm rotation was 139°(range,125°-145°).The mean MEPS was 95 points (range,85-100 points),with 19 excellent results and 2 good results.Concentric stability was restored in all cases.Early post-operative complication occurred in one patient as a wound infection,which healed uneventfully after surgical debridement and antibiotic therapy.Late post-operative complication occurred in four patients including two cases of heterotopic ossification,1 case of radial head nonunion,and one case of ulnar nerve neuropathy,but none of them required additional surgery.Conclusion Lateral approach combined with anteromedial approach for terrible triad of the elbow provided both bony and soft-tissue stability,thereby allowing early active motion as well as functional recovery of the elbow.