Terrible Triad of the Elbow

Abstract

Purpose. To review epidemiological characteristics and treatment outcomes of the terrible triad of the elbow. Methods. Records of 18 cases of the terrible triad of the elbow occurring in 8 women and 8 men aged 17 to 77 (mean, 45) years were reviewed. The epidemiology and various treatment approaches and functional outcomes were recorded. The mean follow-up period was 13.6 (range, 4–38) months. The injury mechanisms included simple falls (n=12), falls from a low height (n=2), traffic accidents (n=2), and sports accidents (n=2). Radial head fractures and the coronoid apophysis fractures were classified. Results. There were 10 type-III and 8 type-II radial head fractures, 9 type-I and 9 type-II coronoid apophysis fractures, and all humeroulnar dislocations were posterior. The mean duration of immobilisation was 25.5 (range, 17–38) days. After rehabilitation, the mean range of motion of the elbow improved to 130° flexion (24% recovery), 18° extension (35% recovery), 73° supination (142% recovery), and 85° pronation (25% recovery). The greatest gain in range of motion occurred within 3 to 4 months. Complications included heterotopic ossification (n=4), blocked pronation and supination (n=4), transient ulnar nerve injury (n=2), Essex-Lopresti lesion (n=2), unnoticed dislocation (n=3), and rapidly progressive arthrosis (n=1). Conclusion. Although our patients had better recovery of range of motion than those reported in other studies, the terrible triad of the elbow can lead to joint instability, osteoarthritis, arthrosis, and joint stiffness, and may resort to total elbow arthroplasty in some cases.