Volume 11, Issue 4 (11-2024)
JROS 2024, 11(4): 221-226 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Najd Mazhar F, Zareie B, Mahmoudi Nasab O, Mohammadi R, Mohammadnab S, Kafiabadi M J et al . Non-operative Management of Terrible Triad Injuries of the Elbow: A Case Series. JROS 2024; 11 (4) :221-226
URL: http://jros.iums.ac.ir/article-1-2282-en.html
URL: http://jros.iums.ac.ir/article-1-2282-en.html
Farid Najd Mazhar1 
, Bushra Zareie1 , Omid Mahmoudi Nasab1 , Reza Mohammadi1 , Sajjad Mohammadnab2 , Meisam Jafari Kafiabadi3 , Hooman Shariatzade1
, Bushra Zareie1 , Omid Mahmoudi Nasab1 , Reza Mohammadi1 , Sajjad Mohammadnab2 , Meisam Jafari Kafiabadi3 , Hooman Shariatzade1
1- Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
2- Department of Orthopedic Surgery, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.
3- Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2- Department of Orthopedic Surgery, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran.
3- Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Abstract: (123 Views)
Background: The terrible triad (TT) injury of the elbow, consisting of ulnohumeral dislocation, radial head fracture, and coronoid process fracture, is traditionally managed surgically. However, recent studies have suggested that non-operative management may be a viable option for select patients.
Objectives: This study evaluates the outcomes of non-operative management in 17 patients with TT injuries treated between 2015 and 2023.
Methods: A retrospective review was conducted on 17 patients who met specific criteria for non-operative management, including congruent joint reduction, no intra-articular fragments, and a stable range of motion (ROM) up to 45 degrees of extension. Functional outcomes were assessed using the Mayo elbow performance index (MEPI) and the disabilities of the arm, shoulder, and hand (DASH) score. A radiographic evaluation was performed to assess joint congruency and the presence of arthritis.
Results: The mean follow-up period was 53.24 months (range: 26-96 months). The mean MEPI score was 95.29±6.95, and the mean DASH score was 5.64±4.06. The mean ROM for the affected elbow was 9.71±5.72 degrees in extension, 130.6±8.27 degrees in flexion, 65.29±10.07 degrees in supination, and 59.71±13.4 degrees in pronation. One patient developed ulnar nerve symptoms and underwent ulnar neurolysis and anterior transposition of the medial epicondyle, and two patients reported occasional painful clicking during supination and pronation.
Conclusion: Non-operative management of TT injuries can yield acceptable functional outcomes in carefully selected patients. However, the potential for reduced supination and pronation, as well as the development of post-traumatic arthritis, should be considered. Further studies with larger cohorts and longer follow-up periods are needed to validate these findings.
Objectives: This study evaluates the outcomes of non-operative management in 17 patients with TT injuries treated between 2015 and 2023.
Methods: A retrospective review was conducted on 17 patients who met specific criteria for non-operative management, including congruent joint reduction, no intra-articular fragments, and a stable range of motion (ROM) up to 45 degrees of extension. Functional outcomes were assessed using the Mayo elbow performance index (MEPI) and the disabilities of the arm, shoulder, and hand (DASH) score. A radiographic evaluation was performed to assess joint congruency and the presence of arthritis.
Results: The mean follow-up period was 53.24 months (range: 26-96 months). The mean MEPI score was 95.29±6.95, and the mean DASH score was 5.64±4.06. The mean ROM for the affected elbow was 9.71±5.72 degrees in extension, 130.6±8.27 degrees in flexion, 65.29±10.07 degrees in supination, and 59.71±13.4 degrees in pronation. One patient developed ulnar nerve symptoms and underwent ulnar neurolysis and anterior transposition of the medial epicondyle, and two patients reported occasional painful clicking during supination and pronation.
Conclusion: Non-operative management of TT injuries can yield acceptable functional outcomes in carefully selected patients. However, the potential for reduced supination and pronation, as well as the development of post-traumatic arthritis, should be considered. Further studies with larger cohorts and longer follow-up periods are needed to validate these findings.
Keywords: Terrible triad injury (TT), Elbow dislocation, Radial head fracture, Coronoid process fracture, Non-operative management, Closed reduction, Joint stability
Type of Study: Research Article |
Subject:
Hand surgery / Elbow
Received: 2025/03/25 | Accepted: 2025/09/27 | Published: 2024/11/20
Received: 2025/03/25 | Accepted: 2025/09/27 | Published: 2024/11/20
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Copyright © The Author(s);
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Contact Information
