This injury almost always renders the elbow unstable requiring surgical intervention. Terrible triad In a Cadaveric elbow study. OPERATIVE TECHNIQUE: Lateral … 6 men aged 26 to 54 years underwent surgery for the terrible triad of the elbow by a single surgeon. The terrible triad of the elbow is a difficult injury with historically poor outcomes. Coronoid Fracture 2. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. Radial Head Fracture 3. Elbow Dislocation. Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad. concepts. 2017 Elbow lat lig recon 6 -10 weeks Splint: -Wean from the splint at 4 weeks if an arthroplasty was performed, and 6 weeks if ORIF. Terrible Triad Injury of the Elbow: Current Concepts Abstract Fracture-dislocations of the elbow remain among the most difficult injuries to manage. Elbow fractures and dislocations cause injury to important stabilizing structures and require specific treatment in order to regain functionality of the elbow joint. resent our formulated protocol and treatment algorithm for el-bow fracture-dislocation in this series of thirty-two patients. A complex triad elbow injury was successfully managed using NPWTi-d. An elbow flexion-extension range of motion of 120° to 20° was achieved in 6 months, allowing for most daily activities. J Am Acad Orthop Surg. These injuries make up about 30% of elbow dislocations, and are generally caused by falling onto an outstretched arm. 'Terrible triad' is a term used to describe a severe complex dislocation with intra-articular fractures of the radial head and coronoid process. terrible triad of the elbow treated with our modified protocol. 2: Mathew PK, Athwal GS, King GJ. - Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. In order for it to recover to its best function consistent rehabilitation is essential in order to obtain the optimal outcome after injury. and Pierrart et al. INDICATIONS: Osteoligamentous terrible triad injury pattern with or without subluxation position following reduction and temporary immobilization. Terrible Triad: Tricks for Dealing with the Unstable Elbow Mark A. Mighell, MD Kaitlyn N. Christmas, BS Disclosure Paid Consultation Research Support Speakers Bureau Paid Consultation Speakers Bureau The Terrible Triad Injury 1. An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. Our results indicate proper diagnoisis , planning with good fixation and rehabilitation protocol gives excellent clinical and radiological outcomes. Liu G, Ma W, Li M, Feng J, Xu R, Pan Z. Operative treatment of terrible triad of the elbow with a modified Pugh standard protocol: retrospective analysis of a prospective cohort. 11/21/2016 2 Biomechanics of Elbow Dislocation May involve bone or soft tissue Radial … CONTRAINDICATIONS: Inoperable due to comorbidities. Methods. Elbow Dislocation Rehabilitation Protocol Elbow Dislocation The Elbow Joint is the most complex joint in the body. Such fractures may be neglected even if some authors recommend capsular reinsertion via anchors with possible excision of the fragment, or a retrograde suture repair tied over the oleocranon. General Trauma Rehabilitation. The goal of treatment for these injuries is to restore the bony and ligamentous structures and provide su cient stability for early range of motion (ROM) [5]. Int Orthop. Rehabilitation protocols from Jill Thomas, Specialist Elbow Physiotherapy Practitioner, Wrightington Hospital. terrible triad injury . elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture . The analyzed aspects of 20 patients, who underwent surgical treatment of the terrible triad of the elbow, were given as follows: Dash score (Disabilities of the Arm, Shoulder and Hand), Meps (Mayo Elbow Performance Score), pain according to VAS (visual analog scale), ROM (range of motion), patient satisfaction, degree of energy of the trauma, complications and radiographs. References: Hotchkiss RN. A review Juan Rodriguez-Martin & Juan Pretell-Mazzini & Eva Maria Andres-Esteban& Fracture-dislocations of the elbow remain among the most difficult injuries to manage. . A review. Learn about recovery and rehabilitation for your unhappy triad surgery Recovery from surgery for an unhappy triad can be a long and intensive process due to the severity of the injury and the surgery. 2017 Elbow med lig recon . Objective Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. Edema Control: Per therapist. All the patients had a displaced comminuted fracture of the radius, posterior dislocation of the elbow, and Morrey type-I fracture of the coronoid. of the elbow [3] Terrible triad injuries can lead to pain, recurrent instability, sti ness, and posttraumatic arthritis if not properly treated [6]. It is important that this be carefully carried out under the supervision of a therapist. Lateral tomogram of an elbow with posterior dislocation, coronoid fracture, and radial head fracture, the so-called “terrible triad” of the elbow. The “terrible triad injury” of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture. We describe a rare case of B/L terrible triad of elbow with associated proximal 1/3rd ulna fracture. Our standard protocol • Rd iReduction of the di l idislocation • ORIF oror ReplacementReplacement ofof radialradial headhead • Repair anterior capsule to coronoid • Repair lateral structures • Brace for 4 weeks • Early ROM at ten days in the brace. 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. radial head fractures occur in up to 10% of elbow dislocations; varus posteromedial rotatory instability . Outcomes after terrible triads of the elbow treated with the current surgical . Elbow dislocations are staged depending on the disruption of the following stabilizers: the ulnohumeral articulation, MCL, and LCL. In terrible triad injuries of the elbow, most coronoid process fractures are type I fractures as confirmed by the series of Doornberg et al. Most patients find their recovery time to be anywhere between 6-9 months depending on how quickly they heal and the extent […] Rehabilitation after lateral ligament reconstruction. 2011 Jun;35(6):851-60. -Begin gentle PROM and continue AROM/AAROM to elbow extension and !exion starting at 4 weeks. -Continue active elbow extension/!exion, as well as active and passive wrist !exion/extension and pro/ supination. Terrible triad injury of the elbow: current . Surgical technique - Treatment strategy of terrible triad of the elbow: Experience in Shanghai 6th People's Hospital. REVIEW Outcomes after terrible triads of the elbow treated with the current surgical protocols. Regardless of whether surgical or non-surgical treatment is performed, correct rehabilitation following diagnosis of the injury pattern is crucial to achieve the best possible outcome in each individual case. Famous Physical Therapists Bob Schrupp and Brad Heineck present the top 3 exercises for straightening the elbow after surgery or injury. Download Dr. Myeroff's Protected Elbow ROM Diagram Information Sheet; Download Dr. Myeroff's Finger ROM Diagram Information Sheet; Download Dr. Myeroff's Ligament Protection Therapy Protocol Information Sheet; Download Dr Myeroff's Post-Op Protocol for Terrible Triad Fracture Dislocation – ORIF The so-called terrible triad injury has a history of com-plicated outcomes as the surgeon attempts to maximize func-tional range-of-motion goals while maintaining stability 1-3. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. Click here to download patient education documents offered by Dr Chad Myeroff in Saint Paul, Minneapolis and Woodbury in MN. Tomograms can often be very useful in defining bony fragments of the radial head (seen on this section) or coronoid. Improved experience, techniques, and implants have advanced to the point where restoration of elbow stability can be expected. protocols. Conclusions. Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad. Concentric elbow with radial head fracture without impairment of pronation/supination, coronoid fragment <50% and stable range of motion up to 30°. - Terrible triad injury of the elbow: how to improve outcomes? 2017 Elbow Trauma Patients . In the current case, the NPWTi-d protocol allowed the authors to achieve a good result, despite the large degloving injury and the severe elbow fracture-dislocation. Methods. 3D CT reconstruction is a practical tool to support diagnosis and formulate surgical plan. Rehabilitation after medial ligament reconstruction. elbow dislocation with associated fracture; may take form of . Epub 2010 May 8. Review. 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