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. - Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. REVIEW Outcomes after terrible triads of the elbow treated with the current surgical protocols. Coronoid Fracture 2. 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. References: Hotchkiss RN. A review Juan Rodriguez-Martin & Juan Pretell-Mazzini & Eva Maria Andres-Esteban& J Am Acad Orthop Surg. 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. Concentric elbow with radial head fracture without impairment of pronation/supination, coronoid fragment <50% and stable range of motion up to 30°. elbow dislocation with associated fracture; may take form of . Outcomes after terrible triads of the elbow treated with the current surgical . 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 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]. These injuries make up about 30% of elbow dislocations, and are generally caused by falling onto an outstretched arm. concepts. This injury almost always renders the elbow unstable requiring surgical intervention. Terrible triad injury of the elbow: current . 11/21/2016 2 Biomechanics of Elbow Dislocation May involve bone or soft tissue Radial … Elbow fractures and dislocations cause injury to important stabilizing structures and require specific treatment in order to regain functionality of the elbow joint. An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. The primary goal of surgery is to stabilize the elbow to permit early motion to prevent stiffness. 2017 Elbow Trauma Patients . Methods. Fracture-dislocations of the elbow remain among the most difficult injuries to manage. A review. Surgical technique - Treatment strategy of terrible triad of the elbow: Experience in Shanghai 6th People's Hospital. 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. -Continue active elbow extension/!exion, as well as active and passive wrist !exion/extension and pro/ supination. INDICATIONS: Osteoligamentous terrible triad injury pattern with or without subluxation position following reduction and temporary immobilization. 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. It is important that this be carefully carried out under the supervision of a therapist. Conclusions. The terrible triad of the elbow is a difficult injury with historically poor outcomes. 'Terrible triad' is a term used to describe a severe complex dislocation with intra-articular fractures of the radial head and coronoid process. protocols. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. terrible triad injury . Int Orthop. . 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. We describe a rare case of B/L terrible triad of elbow with associated proximal 1/3rd ulna fracture. -Begin gentle PROM and continue AROM/AAROM to elbow extension and !exion starting at 4 weeks. Rehabilitation protocols from Jill Thomas, Specialist Elbow Physiotherapy Practitioner, Wrightington Hospital. terrible triad of the elbow treated with our modified protocol. Most patients find their recovery time to be anywhere between 6-9 months depending on how quickly they heal and the extent […] General Trauma Rehabilitation. Elbow dislocations are staged depending on the disruption of the following stabilizers: the ulnohumeral articulation, MCL, and LCL. Improved experience, techniques, and implants have advanced to the point where restoration of elbow stability can be expected. Famous Physical Therapists Bob Schrupp and Brad Heineck present the top 3 exercises for straightening the elbow after surgery or injury. CONTRAINDICATIONS: Inoperable due to comorbidities. Rehabilitation after lateral ligament reconstruction. Methods. In terrible triad injuries of the elbow, most coronoid process fractures are type I fractures as confirmed by the series of Doornberg et al. 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. Tomograms can often be very useful in defining bony fragments of the radial head (seen on this section) or coronoid. elbow dislocation associated with a LUCL tear, radial head fracture, and coronoid tip fracture . 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 Epub 2010 May 8. Review. 2011 Jun;35(6):851-60. Rehabilitation after medial ligament reconstruction. In order for it to recover to its best function consistent rehabilitation is essential in order to obtain the optimal outcome after injury. - Terrible triad injury of the elbow: how to improve outcomes? 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. Lateral tomogram of an elbow with posterior dislocation, coronoid fracture, and radial head fracture, the so-called “terrible triad” of the elbow. Elbow Dislocation Rehabilitation Protocol Elbow Dislocation The Elbow Joint is the most complex joint in the body. Radial Head Fracture 3. Our results indicate proper diagnoisis , planning with good fixation and rehabilitation protocol gives excellent clinical and radiological outcomes. 3D CT reconstruction is a practical tool to support diagnosis and formulate surgical plan. 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. Elbow Dislocation. Click here to download patient education documents offered by Dr Chad Myeroff in Saint Paul, Minneapolis and Woodbury in MN. All the patients had a displaced comminuted fracture of the radius, posterior dislocation of the elbow, and Morrey type-I fracture of the coronoid. 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. resent our formulated protocol and treatment algorithm for el-bow fracture-dislocation in this series of thirty-two patients. 6 -10 weeks Splint: -Wean from the splint at 4 weeks if an arthroplasty was performed, and 6 weeks if ORIF. 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. radial head fractures occur in up to 10% of elbow dislocations; varus posteromedial rotatory instability . OPERATIVE TECHNIQUE: Lateral … 2017 Elbow med lig recon . 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. The “terrible triad injury” of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture. 2: Mathew PK, Athwal GS, King GJ. 6 men aged 26 to 54 years underwent surgery for the terrible triad of the elbow by a single surgeon. Terrible Triad Injury of the Elbow: Current Concepts Abstract Fracture-dislocations of the elbow remain among the most difficult injuries to manage. and Pierrart et al. A complex triad elbow injury was successfully managed using NPWTi-d. 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