Abstract
Dislocation of the elbow with associated fractures of the radial head and the coronoid process of the ulna have been referred to as the “terrible triad of the elbow” because of the difficulties in treating this injury and the poor outcomes.
The orthopaedic database, Orthoscope, was used to identify all patients with dislocation of the ulnohumeral joint and fracture of both the head of the radius and the coronoid process of the ulna, seen and treated at Auckland City Hospital since 1998.
All patients were invited to follow up appointments to evaluate the outcomes achieved. The research protocol was approved by the local research committee. Follow up appointments consisted of clinic al examination, assessing the range of elbow motion, an elbow radiograph and a functional assessment, using the DASH score and the American Shoulder and Elbow Society scoring systems.
There were 32 patients identified, from Orthoscope, and invited for follow up. Six patients, who had moved overseas, were lost to follow up and two others declined follow up. 23 patients (24 elbows) remained for evaluation. All patients returned for the described assessment protocol. There were 10 male patients and 13 female patients, with a mean age of 46.9 (range, 29 to 67 years). The average arc of ulnohumeral motion was 122 degrees (range; 110 degrees to 140 degrees) and that of forearm rotation was 138 degrees (range, 35 degrees to 170 degrees).
The radial head component was fixed in a standard fashion with repair, or replacement, and no radial head excisions were undertaken. Coronoid fractures were treated with screw fixation or suturing, with drill holes or anchors. To augment stability, a lateral ligament repair was undertaken in most patients. All patients, except one, would undergo the procedure again if needed.
Elbow fracture-dislocations are historically very unstable and are prone to numerous complications. With operative treatment of the radial head, with repair or replacement, to restore stability through radiocapitellar contact, coronoid and lateral ligament repair, good range of movement and stability can be achieved.
Correspondence should be addressed to Associate Professor N. Susan Stott, Orthopaedic Department, Starship Children’s Hospital, Private Bag 92024, Auckland, New Zealand.
