A Clinical Study On The Repair Of The Medial Collateral Ligament In The Terrible Triad Of The Elbow

ObjectiveTo evaluate the effect of surgical repair of the medial collateral ligament in cases of terrible triad of the elbow.MethodsThis study included 19 patients who underwent surgery following a diagnosis of terrible triad of the elbow by the same group of surgeons from January 2010 to December 2014,which included 13 males and 6 females with a mean age of 33.2 years old(ranged from 17 to 52 years).In all cases, the coronoid process fracture was first fixed,then the radial head and lateral collateral ligament were repaired. The medial side of the elbow was addressed(medial collateral ligament repair) in 9 cases(the repaired group)and not addressed in the remaining 10 cases(the control group),which was decided by the surgeons according to the stability of elbow joint during the operation.All patients began rehabilitation exercise and received anti heterotopic ossification drug therapy(indomethacin, 25 mg, 3 times per day,for 3 weeks)at the first day after operation.We record and calculate the Mayo score(MEPS) according to the elbow pain, range of motion, stability, function of daily life.All patients were evaluated with clinical and imaging results in 1,3,6,12 months after operation.ResultsAll patients were followed up from 12-36 months(averaged 20.7 months).All patients had gained the stability of the elbow joint.Of them,5 patients felt thesymptoms of pain remission of symptoms,which relieved in 1 month.The elbow heterotopic ossification occurred in 4 cases.1 patient developed the symptoms of ulnar neuritis,which the drug treatment can alleviate.At the last follow-up,in range of motion,flexion,extension,MEPS,the difference were statistically significant(P<0.05).The elbow joint function of the repaired group was better than the control group.ConclusionThe terrible triad of the elbow indicates a complicated joint damage, the injures of bone and soft tissue are serious,which indicates the instability of the elbow.The stability of the elbow should be strictly checked during operation,when necessary,we should repair the medial collateral ligament,the postoperative scientific rehabilitation exercise and drug treatment are also essential, then the elbow joint function can recover satisfactorily.