Vol. 1, Issue 5 (2016)
Terrible triad of the elbow: Outcomes after treatment (Terrible triade du coude : Resultats du traitement)
Author(s): A Magoumou, Y El Andaloussi, K Lamnaouar, R Ait Mouha, K Ahed, AR Haddoun, M Nechad, M Fadili
Abstract: Our work consisted of a prospective study of 7 cases of terrible triad of the elbow collected between January, 2009 and January, 2013 in the Department of orthopedic and traumatology, CHU Ibn Rochd Casablanca (Wing IV). Our patients are 5 men and 2 women whose average age is 32 years. The elbow dislocation was reduced urgently by external maneuver in all patients followed by a verification radiograph and a systematic CT scan of elbow to specify the assessment of the lesions. The treatment was surgical in all patients with osteosynthesis of fractures of the radial head in all cases, the coronoid process was sutured in one case. The radial collateral ligament was fixed in all cases, the medial collateral ligament was achieved in all patients without being repaired. All patients were reviewed with an average follow of 16 months. We evaluated our results on pain intensity, range of motion, stability and function. Mayo elbow score was good in 5 cases, bad in one case and good in one case. One patient had a residual instability, three patients had stiffness and six patients had a periodic pain. The principle of the treatment is based on two main points : to restore the stabilizing bony structures (radial head and coronoid process) and repair the radial collateral ligament. A medial approach is indicated in cases of persistent posterolateral instability after repair of radial collateral ligament or when a large fragment of the coronoid process to synthesize. Our study showed that the terrible triad of the elbow is a diagnostic and therapeutic problem. The management codified by the authors' clinical experience not always provides satisfactory results.