Clinical Analysis Of Surgical Treatment Of Terrible Triad Of The Elbow

Elbow joint is one of the most prone to joint dislocation,and the annual incidence is about 0.006%-0.008%,and about 49% of them had fractures.Posterior dislocation of the elbow with coronoid fractures and fractures of the radial head are collectively referred to as the terrible triad of the elbow.This is a kind of high-energy damage and clinical morbidity is low.Because of the complex mechanism of injury and the difficulty of clinical treatment,the wound has been treated conservatively.In recent years,with the study of biomechanics and the emergence of related implants,there is most articles reported that the stability of elbow joint can be restored by surgical treatment and the function of the elbow joint can be improved.At the present stage,the clinical application of open reduction and internal fixation for the patients who are the terrible triad of elbow joint,and fixation and reconstruction of soft tissue by internal fixation.Our hospital also achieved satisfactory results through surgery for the treatment of patients who are TTI.Purpose: To explore the method and effect of surgical treatment of the terrible triad of the elbow joint.Method: This paper is a retrospective analysis from January 2010 to August 2016,12 cases of patients with elbow triad in the hand surgery and micro-surgery of The first affiliated hospital of Dalian medical university.There were 8 males and 4 females;The average age was 43 years(25-79 years);left in 8 cases and right in the other 4 cases;Cause of injury: 4 cases of falling injuries,8 cases of falling injury;time from injury to surgery was 2-10 days,average 5.5 days;According Regan-Morrey to the classification of coronal fracture,4 cases of I type,4 case of II type,4 case of III;According to Hotchkiss,the modified Mason classification of radial head fracture was presented in 2 cases of type I,type II in 3 cases and type III in 7 cases;All cases were closed fractures,which merge pelvic fractures in 1 case,the merger of L2,3 of the fractured vertebral body in 1 case and No neurovascular injury symptoms.Preoperative X-ray and CT scan and reconstruction of elbow joint,And,according to the condition,the lateral approach of elbow joint,the medial and lateral approach of elbow joint,the anterior approach of elbow joint and elbow joint.Fixation of radial head or radial head prosthesis with steel plate and cannulated screw,cannulated screws or anchors for the repair of coronal and elbow ligaments,The elbow flexion was 90 degrees after operation,and the lateral position of the forearm was fixed.After second days of elbow joint passive functional exercise,and after three weeks of removal of gypsum,the patients were given active and passive exercises.The patients were followed up regularly,and the elbow function and imaging were recorded and evaluated.The fracture healing time was recorded according to the standard of clinical healing,and the MEPS score was used to evaluate the function.Result: All 12 patients were followed up for an average of 51 months(range 8 to 82 months),1 case of fracture nonunion,accounting for more than 8.3% of all patients,more than patients with fracture healing and the average healing time was about 3 months.At the last follow-up,the average activity of the elbow joint was 120°±9.29°,and the flexion of the elbow was as high as 125°±5.64°,and straight-5°±4.26°.Forearm pronation 81.67°±6.07°,forearm rotation after 81.67°± 5.27°.Mayo elbow score was used to evaluate the results.The results were excellent in 8 cases,good in 3 cases and fair in 1 case,with an excellent and good rate of 91.66%.None of the patients in this group had infection,implant loosening,fracture and elbow instability.Conclusion: The surgical treatment of the elbow triad can reconstruct the anatomic structure of elbow joint and restore the stability of elbow joint,and do exercise as soon as possible to improve elbow function.