A Clinical Study On The Necessity Of Surgical Treatment Of The Scary Triad Of The Elbow Medial Collateral Ligament

Purpose:To investigate the effect of the repair of medial collateral ligament on the trigemma of the elbow during the surgical treatment.In patients with postoperative follow-up summary,comparison according to the operation rules,obtain better stability after treatment has been without vice toughening repair of patients with the medial between the patients with the medial collateral ligament repair,disease prognosis results of different statistical analysis,conclusion,to expect to operation scheme for such fractures play a reference role.Materials and Methods:A retrospective study was conducted on the patients with terrible triad of elbow joint operated by the same surgeon in the department of orthopaedics of our hospital from January 2012 to January 2017.All patients underwent internal fixation of ulnar coronoid fracture,radial head fracture fixation and repair of the lateral collateral ligament of the elbow joint successively within 6h ~ 7d(mean 5.5d)after injury.Participants ranged in age from 17 to 57 years(mean 33.3years).There were 16 male patients and 7 female patients with a total of23 patients.The grouping was based on whether the medial collateral ligament was repaired during the surgery.Among them,11 patients underwent the repair of the medial collateral ligament during the surgery,which was designated as the repair group;the remaining 12 patients did not receive further treatment of the medial collateral ligament of theelbow joint as the control group due to the intraoperative determination of good stability of the elbow joint.All patients received functional exercises of shoulder joint,wrist joint and finger joint independently on the first day after surgery,supplemented by plaster,and began to receive rehabilitation exercises of elbow joint within one week(5d ~ 7d)according to individual specific conditions.At each patient's last follow-up,the degree of elbow pain,elbow flexion and extension,elbow stability,and daily elbow function were recorded.The Mayo elbow function score(MEPS)was recorded for each patient.Each individual was followed up regularly for a long time after surgery and reexamined after surgery.Result:According to the statistics,all the 23 patients had reached the inclusion criteria,that is,the follow-up time was up to 12-36 months(the average follow-up time was 22.4 months),with stable joints,no deformity,re-dislocation and joint stiffness.Four of the patients had pain in the elbow joint after discharge,but all of them had pain relief within 1 to 3months.There were 4 cases of elbow heterotopic ossification and 2 cases of arthritis.At the end of follow-up,statistical analysis was performed on the elbow flexion and extension range,forearm rotation range,forearm rotation range,flexion,extension Angle and elbow Mayo function score(MEPS)between the two groups.No significant difference was found between the two groups at the level of 0.05 in elbow flexion and extension range,flexion and extension Angle.Repair group and controlgroup in elbow forearm pronation Angle at the 0.05 level exists significant difference(p = 0.021)pronation Angle Angle of forearm supination significant differences at the 0.001 level(after rotation Angle p= 0.001)think that although the elbow forearm pronation and supination statistical differences in the two groups,group but to repair the function of the patient's elbow is not significantly better than the control group.conclusion:The elbow joint is characterized by complex structure and precise movement.The scary triad of the elbow joint causes serious damage to the bone structure of the elbow joint and damages the surrounding soft tissue,which seriously affects the stability of the elbow joint.The terrible triad of elbow joint is also easy to cause all kinds of elbow joint complications and seriously affect the patient's daily life.Recovery of the stability and early rehabilitation of the elbow joint play a decisive role in the prognosis of the terrible triad of the elbow joint.In the process of surgery,conventional reduction and fixation of ulnar coronal process fractures,radial head fractures and repair of the lateral collateral ligament are beyond doubt.In terms of elbow joint function,the repair of medial collateral ligament may bring less clinical effect.When the ulnar coronoid process,radial head and lateral collateral ligament are repaired without residual instability,the repair process of medial collateral ligament of elbow joint is not necessary.Correct and timely rehabilitation after surgery can provide good long-term prognosis and functional activities of the elbow joint.