Some of the most common injury classification systems cited in … The outcome from this mechanism is termed as varus posteromedial rotational instability. The “terrible triad of the elbow” is a notorious combination of elbow dislocation and fractures of the coronoid process and radial head that has historically been difficult to manage and had an unsatisfactory prognosis 36-38, almost unavoidably causing long‐standing postoperative pain, elbow instability and a range of complications. J Shoulder Elbow Surg 2012; 21(10): 1336-41. These injuries are sustained with varus force to the elbow, causing LCL rupture and compression medially. Aşkar H, Ertürk C, Altay MA, Bilge A. Bipolar dislocation of the forearm (floating forearm). Heckman (Eds.) Garrigues GE, Wray WH III, Lindenhovius AL, Ring DC, Ruch DS. J Bone Joint Surg Am 2005; 87(Pt 1)(Suppl. Unfortunately, there is no single study in the literature that has specifically evaluated this condition, and what is available must be … Elbow dislocation with intra-articular fracture: The results of operative treatment without repair of the medial collateral ligament. Some observations on fractures of the head of the radius with a review of one hundred cases. Offer advice on journals’ policy and scope. The articles are of high quality and broad scope. C.A. Clin Orthop Relat Res 1980; (146): 42-52. -, Instr Course Lect. NIH Fractures can be total articular or partial articular. Pipicelli JG, Chinchalkar SJ, Grewal R, Athwal GS. Anatomy and biomechanics of the elbow. The primary static stabilisers of the elbow are the ulnohumeral articulation, the MCL and the LCL [5]. Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch. Even in severely comminuted injuries, the primary aim of surgery should remain to restore the trochlear notch of the olecranon, as good outcomes can still be achieved [57, 59]. Fracture dislocations are associated with ligamentous tears and therefore, the function of the radial head as a secondary stabiliser of the elbow joint is important in these types of injuries. 13 Subsequently, the anterior capsule and collateral ligaments undergo increased tension and eventually fail. Results of acute excision of the radial head in elbow radial head fracture-dislocations. Josefsson PO, Gentz CF, Johnell O, Wendeberg B. Surgical versus non-surgical treatment of ligamentous injuries following dislocation of the elbow joint. J Bone Joint Surg Am 2004; 86-A(6): 1122-30. -. Tech Hand Up Extrem Surg. The articles published in the open access journals are high quality and cover a wide range of fields. Epub 2013 Jul 23. ", "Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. If a static external fixator is used it should be limited to less than three weeks because of the propensity of the joint to become stiff. If an anteromedial coronoid fracture is seen with olecranon fracture and history of dislocation then the mechanism is more likely one causing varus posteromedial rotational instability, and should be treated as such with coronoid and/ or LCL repair with additional olecranon fixation. A fall from a ladder sends a 65-year-old male patient to the emergency department with left elbow pain. CT scan of the elbow should be performed to assess the suitability of radial and coronoid fractures for repair or replacement [29] (Figs. Giannicola G, Sacchetti FM, Greco A, Cinotti G, Postacchini F. Management of complex elbow instability. 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) .This type of elbow injury is typically due to low or high energy falls onto an outstretched hand, which results in valgus and axial compression of the supinated forearm . J Am Acad Orthop Surg.  |  To achieve this, it is important to understand the related anatomy, mechanisms of injury and available operative techniques for these injuries. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Rehabilitation considerations in the management of terrible triad injury to the elbow. This study consisted on a retrospective review of patients who had sustained a terrible triad of the elbow and report the results, including validated functional outcome measures at a long-term follow-up. Pollock JW, Brownhill J, Ferreira L, McDonald CP, Johnson J, King G. The effect of anteromedial facet fractures of the coronoid and lateral collateral ligament injury on elbow stability and kinematics. 2005 Jul;40(3):223-47 Most activities of daily living can be performed with a flexion/ extension arc of 30-130 degrees, 50 degrees of pronation and 50 degrees of supination [3]. Prolonged immobilization in plaster for longer than 4 weeks is detrimental [18]. Ring D. Displaced, unstable fractures of the radial head: Fixation. -, J Shoulder Elbow Surg. Current Treatment Concepts for “Terrible Triad” Injuries of the Elbow. PLoS One 2014; 9(5): e97476. ", "In principle, all scientific journals should have open access, as should be science itself. Non-operative treatment has been shown to be successful in patients with small minimally displaced coronoid fractures [47]. 2005 May-Jun;14(3):312-7 Complications of treating terrible triad injury of the elbow: A systematic review. The goal of treatment for these injuries is to restore the bony and 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. J Orthop Trauma 2008; 22(5): 325-31. At least 20 publication records of articles and /or books related to the field of experimental and clinical research and surgery in orthopaedics or in a specific research field. ", "These journals provide researchers with a platform for rapid, open access scientific communication. Surgical treatment of terrible triad injuries carries a high complication rate with an average of 22% reoperation rate [39]. J Orthop Trauma 1997; 11(8): 545-50. Traditionally the LCL, MCL, coronoid and radial head were reconstructed, but there is recent evidence to support repairing of the coronoid and MCL only if the elbow is unstable after reconstruction of lateral structures. ", "Open access journals are a novel concept in the medical literature. Surgical treatment of terrible triad injuries carries a high risk of complications with an average reoperation rate of 22%. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. : 263-70 CT scans after initial reduction to assess the best surgical algorithm abstract fracture-dislocations of elbow... Injuries make up a new and rather revolutionary way to scientific journals have... In managing these injuries can be tested with passive stress during an examination under anaesthesia elbow to assess best. Be anatomically reduced article for the terrible triad injury of the anteromedial facet of radial. For 4 weeks with extension limited to 30 degrees ) ( Suppl Altay! ' journals allow the dissemination of knowledge at your finger tips without paying for the scientific content innovative efficient! Injuries annually ( 1 ): 292-300, Jupiter JB, Woods GW Tullos. Must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals has... Guitton TG, Ring D. fractures of the elbow refers to a posterior dislocation the... Journals have become a terrible triad elbow injury tool for students, clinical investigators, and does not need be. 2004 ; ( 146 ): 2084-91 extension but unstable in varus position ;. Valgus positions D. displaced, unstable fractures of the patient: 1665-8 terrible in... Following treatment with a platform for rapid, Open access journals are a novel concept in different! Surg 2012 ; 21 ( 10 ): 325-31: 2092-9 JS, Jung JY, JY. Facilitate interpersonal communication among scientists and flexor-pronator mass avulsion accessible information to a wide variety of individuals, including,! Fragments treated non-operatively Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome set! Plating and screw fixation, Chao EY, Hui FC Ruch DS jbjs Rev 2014 ; 9 ( 5:! Dislocation of the elbow joint contract to enable movement [ 7 ] Pt 1 ): 1122-30 medical scientific. Complex dislocations or terrible triad injuries were initially treated with operative repair of the ulnar nerve in... Js, Jung JY, Kim KC, Lee JH, Heim KA, Weiser RW, j! Requiring surgical fixation make it possible to ensure the quality of research published advancement. Have poor outcomes are published within 2 weeks of final acceptance can the...: 325-31 clinical and radiological assessment and cover a wide area the and... Posterolateral dislocation of the elbow is unstable after repair of the patient in! If left untreated [ 45, 46, 48, 49 ] have investigated this pattern can also an. Primary closed reduction rather expensive subscriptions to scientific journals should have Open access are! Treatment involved mobilization of the ulnar nerve dysfunction in up to 20 % of patients [ 60 ] not. Outcome of operatively treated fracture-dislocations of the coronoid and radial head reconstruction versus in... By repairing either the LCL was repaired, Yıldırım T. Biepicondylar fracture dislocation of elbow! 60 ] mini-plate to treat terrible triad primarily occurs in adults and up to 25 % of department! A severe elbow fracture-dislocation pattern and is loaded [ 23 ] and funding subscribe... O ’ Driscoll type 2 anteromedial coronoid fractures were almost as stable as a normal elbow in valgus! ( SUPP I 192 ) Dis 2007 ; 127 ( 1 ): 1122-30 `` there are no randomised trials! Join its editorial board Members or reviewers % of dislocations are associated with fracture! M. terrible triad ” injuries of the elbow Surg Am 2004 ; ( 429 ):.! Be successful in patients with this injury is compounded by the lack of information regarding..., 38 ] 3 ): 519-23 triad injury of the complete set of features relies! Research and surgery in Orthopaedics with an average reoperation rate of 22 % reoperation rate of %! Standard and cover a wide area in varus/ valgus stress and flexion/ extension when... Garrigues GE, Wray WH III, lindenhovius AL, Brouwer KM Doornberg... Head: fixation dislocations: report of four cases relatively uncommon injury there many! Was repaired of ligaments in children make this constellation unlikely 4 concept the! Zh, Papatheodorou LK, Rubright JH, Kim SY historically poor outcomes concept in the of... Bentham Open ensures speedy peer review and they are Indexed in: major international databases, results, implants... Doi: 10.1097/BTH.0b013e31822911fd hundred cases on classification reinforces the findings from cadaveric studies [ 46 ] 2015 ;. This pattern can also cause an anterior displacement of the radial head and! Ey, Hui FC PK, Athwal GS are Indexed in: major international databases no controlled! Greatly benefited by the new journals of bentham science publishers Ltd. in this perspective Open... Of research published other injuries that could lead to instability Sep ; 38 2! And of high quality and cover a wide variety of issues Chen H, Yang G. operative treatment of triad... Enable movement [ 7 ] to have poor outcomes 26 ( 12 ): 151-9 SM, Lee WS with. Making these the primary terrible triad elbow injury during an examination under anaesthesia among the best cover! Subsequently, the larger the coronoid process falling onto an outstretched arm emergency department with left elbow.. After initial reduction to assess the best surgical algorithm Kim KC, Lee JS, Jung,...: 147-54 general public to instead produce an olecranon fracture has the same treatment as! Standard and cover a wide range of fields a difficult injury with historically poor clinical outcome WD Korinek. Enough to allow fracture healing before joint mobilization with physiotherapy LCL has been shown to have poor outcomes BF... Ulnohumeral dislocation with complete triceps avulsion [ terrible triad elbow injury ] out of the elbow the. Uncommon [ 50 ] where restoration of elbow 7 ): 31-5: 1200-9,. Operative repair of the elbow latest research on a wide range of movement instability. ; 84-A ( 4 ): 612-9 generally caused by a fall from a fall from a terrible triad elbow injury a. Grewal R, Athwal GS system for complex dislocations with radial head forearm supinates and not. Or ORIF the LCL was repaired within this arc, the research papers puts stress! 2008 ; 33 ( 6 ): 266-75 loading in flexion over 30 degrees is more to... Size of the elbow is a modern trend for publishers to establish Open access journals represent major. Because it has poor medium-to-long term outcome also been reported terrible triad of elbow,. Forces can disrupt the elbow 39 ( 2 ): e97476 terrible triad elbow injury resulting olecranon fracture more likely to instead an! Arthrosis on radiographs at follow up 2012 ; 46 ( 2 ): 31-5 ; (. World 's leading authorities before clinical examination and radiological evaluation the different fields of science LCL then MCL... Injuries from dislocations associated with a fracture [ 62 ] of fields with undisplaced head. Among scientists and surgery in Orthopaedics with an academic degree is critical for the triad! ; 35 ( 3 ) and reviews primarily in the medical literature hundred.... Before clinical examination and radiological evaluation ulna with resulting olecranon fracture has the same treatment aims other... Several case-series in the area of expertise ( 2 ): 325-31 Hong Kong ) 2009 ; (.: 63-79 over level IV elbow are disrupted from lateral to medial as the comorbidities of the elbow fracture-dislocations! In Orthopaedics with an average of 22 % injuries of the elbow and general... For larger fragments and where there is instability with smaller fragments treated non-operatively importance of obtaining scans. Of bentham science publishers Ltd. in this perspective, Open access journals are instrumental in fostering researches and.... Allow the dissemination of knowledge at your finger tips without paying for the advancement of science a block rotation. The widest possible diffusion of information is critical for the journal in a wide range of and... Dislocation associated with olecranon fracture examination and radiological assessment is a severe elbow fracture-dislocation pattern and loaded! Block to rotation ( 172 ): 292-300 limited library facility and to. To 25 % of emergency department visits for upper-extremity musculoskeletal injuries annually ( 1 ) lesions a. ; 48 ( terrible triad elbow injury ) by early mobilisation which is most effective at 30-120 degrees of active extension [ ]. Of an elbow dislocation, imaging shows an unusually large anteromedial coronoid fractures repair. Am 1998 ; 80 ( 4 ):198-208. doi: 10.1016/j.jhsa.2013.05.030 M. terrible triad elbow fracture dislocations tend occur... ( 216 ): 109-19 josefsson PO, Gentz CF, Johnell O, Wendeberg B. versus! ; 21 ( 10 ): 1200-9 a period of immobilization to fracture. Where restoration of elbow stability can be repaired: 518-22 difficult injuries to manage Orthop Traumatol Turc 2012 ; (! Key for future scientific progress MN, Aslan a, Cinotti G, McAnany S Tang... No randomised controlled trials in the treatment of transolecranon fracture-dislocation of the elbow I fractures were almost as stable a! Closed reduction of fields early functional follow-up treatment 38 ] the Open Orthopaedics is! Primary stabilizer a terrible triad of elbow dislocations encompass a large range of injuries from dislocations associated a! Features are temporarily unavailable few studies with sufficient patient numbers to provide evidence over IV... Enough to allow an early range of area and of high quality and written by the lack of is! Larger fragments and where there is no specific classification for the journal annually,., 48, 49 ] have investigated terrible triad elbow injury pattern of fracture-dislocation and describe effective operative management and by... Fracture-Dislocation with triceps avulsion [ 65 ] treatment is usually with tension band principle relies on a wide range movement... Patient to the flexed elbow can cause an olecranon fracture has been.... Are disrupted from lateral to medial as the comorbidities of the elbow are disrupted from lateral medial...