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Inicio Revista Española de Cirugía Ortopédica y Traumatología (English Edition) Surgical treatment protocol for elbow “terrible triad”
Información de la revista
Vol. 54. Núm. 6.
Páginas 357-362 (noviembre - diciembre 2010)
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Vol. 54. Núm. 6.
Páginas 357-362 (noviembre - diciembre 2010)
Original article
Acceso a texto completo
Surgical treatment protocol for elbow “terrible triad”
Tratamiento quirúrgico protocolizado de la «tríada terrible» de codo
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3284
D. Cecilia López
Autor para correspondencia
dacecilia@hotmail.com

Corresponding author.
, L. Suárez Arias, M.A. Porras Moreno, A. Díaz Martín, F. Jara Sánchez, C. Resines Erasun
Orthopaedic Surgery and Traumatology Department, “12 de Octubre” University Hospital, Madrid, Spain
Este artículo ha recibido
Información del artículo
Abstract
Objective

To analyse the results in patients with the combination of elbow dislocation and fracture of the radial head and the coronoid process (or «terrible triad» of elbow) using a standardised protocol.

Material and methods

A prospective longitudinal study of 24 patients, 10 women and 14 men, median age was 53 years, diagnosed and operated of elbow triad using a standardised protocol The mean follow-up was two years (12–50 months). Treatment included replacement or osteosynthesis of the radial head, repair or osteosynthesis of the coronoid fracture and ligament repair. The results were evaluated clinically using the Mayo scale Elbow Performance Score (MEPS) and radiographically.

Results

The final average mobility was 105° of flexion-extension and 150° of pronosupination. The average score according to the MEPS level was 85 (65–100 points). No patient required re-intervention although there were two complications: one had a superficial infection and in another a residual fragment of the radial head remained that was not removed during surgery.

Conclusion

The treatment for the «terrible triad» of the elbow should maintain a stable joint, preserving or replacing the radial head, repairing the lateral collateral ligament complex, and synthesis of the coronoid fracture.

Keywords:
Elbow
Triad
Radial head
Resumen
Objetivo

Analizar nuestros resultados en pacientes tratados quirúrgicamente por asociación de luxación de codo con fractura de la cabeza radial y fractura de la apófisis coronoides o «tríada terrible» de codo, con un protocolo estandarizado.

Material y métodos

Estudio longitudinal prospectivo de 24 pacientes, 10 mujeres y 14 hombres, con 53 años de edad media, diagnosticados de tríada de codo e intervenidos de forma protocolizada. El seguimiento medio fue de dos años (12–50 meses). El tratamiento incluye la sustitución u osteosíntesis de la cabeza radial, la reparación u osteosíntesis de la fractura de coronoides y la reparación ligamentosa. Los resultados se valoraron con la escala Mayo Elbow Performance Score (MEPS) y radiográficamente.

Resultados

La movilidad media final fue de 105° flexo-extensión y 150° de prono-supinación. La puntuación media en la escala MEPS fue de 85 (65–100 puntos). Ningún paciente precisó de reintervención aunque un caso presentó una infección superficial y en otro persistió un fragmento residual de la cabeza radial que no se extirpó durante la cirugía.

Conclusión

El tratamiento recomendado en la tríada terrible de codo debe mantener una articulación estable, preservando o sustituyendo la cabeza radial, reparando el complejo del ligamento lateral externo e intentando sintetizar la fractura de la coronoides.

Palabras clave:
Codo
Tríada
Cabeza radio
El Texto completo está disponible en PDF
References
[1.]
R.N. Hotchkiss.
Fractures and dislocations of the elbow.
Rockwood and Green's fractures in adults, 4th ed., pp. 929-1024
[2.]
M.D. McKee, S.H. Borden, G.J. King, S.D. Patterson, J.B. Júpiter, H.B. Bamberger, N. Paksima.
Management of recurrent, complex instability of the elbow with a hinged external fixator.
J Bone Joint Surg Br, 80 (1998), pp. 1031-1036
[3.]
P.O. Josefsson, C.F. Gentz, O. Johnell, B. Wendeberg.
Dislocations of the elbow and intraarticular fractures.
Clin Orthop Relat Res, 246 (1989), pp. 126-130
[4.]
R.L. Linscheid.
Elbow dislocations.
The elbow and its disorders, pp. 414-432
[5.]
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
[6.]
D. Pugh, L.M. Wild, E. Schemitsch, G.J.W. King, D. Mc Kee.
Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures.
J Bone Joint Surg Am, 86 (2004), pp. 1122-1130
[7.]
R.E. Cook, M.D. McKee.
Techniques to tame the terrible triad: unstable fracture dislocations of the elbow.
Oper Tech Orthop, 13 (2003), pp. 130-137
[8.]
Zeinders GJ, Patel MK. Management of unstable elbows following complex fracture-dislocations-the “terrible triad” injury. J Bone Joint Surg (Am); 90-A (suppl 4):75-84.
[9.]
M.D. McKee, D.W. Pugh, L.M. Wild, E.H. Schemitsch, G.W. King.
Standard surgical protocol to treat elbow dislocation with radial head and coronoid fractures. Surgical technique.
J Bone Joint Surg Am, 87 (2005), pp. 22-32
[10.]
M.A. Broberg, B.F. Morrey.
Results of delayed excision of the radial head after fracture.
J Bone Joint Surg Am, 68 (1986), pp. 669-674
[11.]
H. Hastings, T.J. Graham.
The classification and treatment of heterotopic ossification about the elbow and forearm.
Hand Clin, 10 (1994), pp. 417-437
[12.]
D.R. Gill, B.F. Morrey.
The Conrad-Morrey total elbow arthroplasty in patients who have rheumatoid arthritis. A ten to fifteen-year follow-up study.
J Bone Joint Surg Am, 80 (1998), pp. 1327-1335
[13.]
E.V. Cheung, S.P. Steinmann.
Surgical approaches to the elbow.
J Am Acad Orthop Surg, 17 (2009), pp. 325-333
[14.]
M.A. Broberg, B.f. Morrey.
Results of treatment of fracture-dislocations of the elbow.
Clin Orthop Relat Res, 216 (1987), pp. 109-119
[15.]
B.F. Morrey, S. Tanaka, K.N. An.
Valgus stability of the elbow: A definition of primary and secondary constraints.
Clin Orthop Relat Res, 256 (1991), pp. 187-195
[16.]
U. Heim.
Les fractures associées du radius et du cubitus au niveau du coude chez l’adulte.
Rev Chir Orthop Reparatrice Appar Mot, 84 (1998), pp. 142-153
[17.]
M. Ikeda, K. Sugiyama, C. Kang, T. Takagaki, Y. Oka.
Comminuted fractures of the radial head.
J Bone Joint Surg Am, 87 (2005), pp. 76-84
[18.]
I.J. Harrington, A. Sekiyi-Out, T. Barrington, D.C. Evans, V. Tuli.
The functional outcome with metallic radial head implants in the treatment of unstable elbow fractures: a long-term review.
J Trauma, 50 (2001), pp. 46-52
[19.]
G.W. King.
Management of radial head fracture with implant arthroplasty.
J Am Soc Hand Surg, 4 (2004), pp. 11-26
[20.]
J.Y. Alnot, V. Katz, P. Hardy.
La prothèse de tête radiale GUEPAR dans les fractures récentes et anciennes.
Rev Chir Orthop, 89 (2003), pp. 304-309
[21.]
N. Popovic, P. Gillet, A. Rodriguez, R. Lemaire.
Fracture of the radial head with associated elbow dislocation: results of treatment using a floating radial head prosthesis.
J Orthop Trauma, 14 (2000), pp. 171-177
[22.]
T. Judet, C. de Loubresse, C. Garreau, P. Piriou, G. Charnley.
A floating prosthesis for radial head fractures.
J Bone Joint Surg Br, 78 (1996), pp. 244-249
[23.]
G.J.W. King, Z. Zarzour, D. Rath, C. Dunning, S. Patterson, J. Johnson.
Metallic radial head arthroplasty improves valgus stability of the elbow.
Clin Orthop, 368 (1999), pp. 114-125
[24.]
D.I. Rosenthal, A.E. Rosenberg, A.L. Schiller, R.J. Smith.
Destructive arthritis due to silicone: a foreign-body reaction.
[25.]
R.A. Worsing, W.D. Engber, T.A. Lange.
Reactive synovitis from particulate silastic.
J Bone Joint Surg Am, 64 (1982), pp. 581-585
[26.]
R. Van Riet, F. Van Glabbeek, O. Verbogt, J. Gielen.
Capitellar erosion caused by a metal radial head prosthesis.
J Bone Joint Surg Am, 86 (2004), pp. 1061-1064
[27.]
Y. Allieu, M. Winter, J.P. Péquignot, P. De Mourgues.
Radial head replacement with a pyrocarbon head prosthesis: preliminary results of a multicentric prospective study.
J Hand Surg [Am], 16 (2007), pp. 1-9
[28.]
W. Regan, B. Morrey.
Fractures of the coronoid process of the ulna.
J Bone Joint Surg Am, 71 (1989), pp. 1348-1354
[29.]
S.W. O’Driscoll, J.B. Jupiter, H. Cohen, D. Ring, M.D. McKee.
Difficult elbow fractures: pearls and pitfalls.
Inst Course Lect, 52 (2003), pp. 113-134
[30.]
C. Forthman, M. Henket, D.C. Ring.
Elbow dislocation with intraarticular fracture: the results of operative treatment without repair of the medial collateral ligament.
J Hand Surg [Am], 32 (2007), pp. 1200-1209
[31.]
P.K. Mathew, G.S. Athwal, G.W. King.
Terrible triad of the elbow: current concepts.
J Am Acad Orthop Surg, 17 (2009), pp. 137-151
Copyright © 2010. Sociedad Española de Cirugía Ortopédica y Traumatología (SECOT)
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