Abstract
Fracture dislocations of the elbow are complex injuries that have a significant risk of long term instability and loss of function. The more severe injuries are fortunately rare and the published series are relatively small. This in turn means that there is less precise evidence and guidance as to the optimal treatment.
With the improvements in the understanding of this injury we consider that the prognosis is not necessarily as poor as has been previously reported and we have attempted to quantify this in a prospective, single surgeon series with standard surgical and rehabilitation protocols using dedicated upper limb physiotherapists.
Methods All patients presenting to the hospital with a terrible triad injury were seen by the senior author for assessment and treatment. Early surgical reconstruction was performed under general anaesthetic by the senior author. Radial head fractures were treated by fixation or prosthetic replacement. Ligament reconstruction or reinforcement was performed where needed. Following surgery early mobilisation was performed using dedicated upper limb physiotherapists.
Information was collected prospectively recording function and stability. All patients were assessed with the Mayo clinic elbow score and the AAOS Disability of the Arm Shoulder and Hand score (DASH).
Results Eleven patients were admitted with a terrible triad injury to their elbow. All were the result of an acute traumatic episode. Follow up was for a mean of 21 months and no patients were lost to follow up.
All fractures had united and there were no cases of migration or failure of metal fixation devices. There were no cases of symptomatic instability and no patient had signs of instability when assessed at clinically.
A mean flexion arc of 106 degrees was recorded (range 60–145) with a mean extension limit of 23 degrees (range 0–40). Pronation and supination arcs were recorded with a mean of 127 degrees of rotation (range 0–160)
There were no reoperations for infection or instability amongst this group of patients
Mayo clinic performance index for the elbow produced a mean score of 91.5 with a range of 85–100 which equates to a good or excellent outcome for all patients.
Conclusion We have demonstrated that with a combination of early surgical stabilisation of bony injuries and restoration of ligamentous stability coupled with a specialised rehabilitation programme can give excellent results in what was once felt to be a catastrophic injury.
Theses abstracts were prepared by Professor Roger Lemaire. Correspondence should be addressed to EFORT Central Office, Freihofstrasse 22, CH-8700 Küsnacht, Switzerland.
