The Clinical Effect Of Radial Head Arthroplasty Combined With Collateral Ligament Reconstruction Via Anchor Nail For The Terrible Triad Of The Elbow Joint

Objective:To probe the operative indication and clinical effect of the therapy combining radial head prosthesis replacement with collateral ligaments reestablishment by suture anchor to treat the elbow terrible triad.Methods:The study dovetailed 5 patients who were suffering from the elbow terrible triad combined with insertion avulsion of collateral ligaments of our department from September 2013 to May 2015,including 1 female and 4 male with a mean age of 36.8 years old(ranging from 28 to 46 years old).The female patient mergered with the olecroanon fracture.5 operations were carried out by a same surgeon with the protocol:fixation of the coronoid process(and olecroanon)of ulna,radial head prosthesis replacement and collateral ligaments reestablishment by suture anchor,through a lateral insicion or an anterior one united.Measures were taken to relieve pains after operation and functional exercises.Each patient was evaluated by Mayo Elbow-Performance Score(MEPS)from 4 aspects as follows:ache,motion,stability and activities of daily living at the last follow-up.Results:5 patients were all followed by a duration of 6-24 months.All fractures healed clinically,the elbows maintained stability,except the median nerve paralysis after operation and recovered automatically of the female patient,without other complcations,such as,insicion infection,heterotopic ossification,ostarthritis or a loose prosthesis.The mean score of MEPS is 87.The clinical effect meet the needs of patients' daily living with a fair satisfaction.Conclusion:1 To conduct open reduction and internal fixation(ORIF)of ulnar coronoid process,radial head prosthesis replacement with collateral ligaments reestablishment by suture anchor,a single lateral insicion of the elbow joint simplify the operating procedure and reduce the risk of vessel and nerve injuries.2 Prosthesis replacement should be conducted to repair Mason classification type ? of the radial head ORIF can't make up,and fill the space after radial head resection,restoring and maintaining the stability of the elbow joint.3 Collateral ligaments reestablishment by suture anchor has some advantages:shortening operative time,sound fixation,high resistance,enhancing location accuracy and lowering the extent of suture abrasion.