Winter M, Chuinard C, Cikes A, Pelegri C, Bronsard N, de Peretti F
Pôle membre supérieur, polyclinique Saint-Jean, consultation bâtiment A, 53, avenue des Alpes, 06800 Cagnes-sur-mer, France.
Chir Main. 2009 Jun;28(3):158-67. doi: 10.1016/j.main.2009.02.003. Epub 2009 Mar 17.
The "terrible triad" of the elbow is the combination of an elbow dislocation, radial head and a coronoid process fracture. Because of a combined sagittal, frontal and transverse instability, these injuries are notoriously difficult to treat. We report our results with a technique for reconstruction of "terrible triad" injuries with either no facture or a type I fracture of the coronoid process in addition to a non-reparable radial head fracture. The hypothesis of this study was that standard surgical treatment of this lesion using a "deep to superficial" stabilisation by a single lateral approach and radial head replacement enables early and reliable functional results.
From June 2004 to January 2007, 13 patients with an average age of 40 years at the date of trauma (range 18-77) underwent reconstruction of a "terrible triad" injury of the elbow with the same technique. The mean follow-up was 25 months (range 15-48).
Eighty-four percent of the patients were very satisfied and satisfied. Average flexion was 131 degrees (110-140). Average extension was -11 degrees (-30-0). Average pronation was 72 degrees (40-80). Average supination was 70 degrees (50-80). The grip strength averaged 75% of that of the non-injured side (50-105). All elbows were stable at review. Eight complications occurred.
Our results suggest that some terrible triad injuries can be successfully managed with deep to superficial stabilisation by lateral approach, consisting in three-dimensional stabilisation done by anterior capsular reinsertion with absorbable anchors, radial head replacement and lateral collateral ligament repair. This standard management provides enough stability to allow early active rehabilitation, preventing post-operative instability and stiffness. This procedure appears to be reliable and reproducible.
肘关节“三联征”是指肘关节脱位合并桡骨头和冠状突骨折。由于存在矢状面、额状面和横断面的联合不稳定，这些损伤治疗起来 notoriously 困难。我们报告了一种治疗“三联征”损伤的技术结果，这些损伤包括无骨折或冠状突 I 型骨折，以及不可修复的桡骨头骨折。本研究的假设是，采用单一外侧入路“由深至浅”稳定化并进行桡骨头置换的标准手术治疗能够实现早期且可靠的功能结果。
2004 年 6 月至 2007 年 1 月，13 例平均年龄 40 岁（范围 18 - 77 岁）的患者在受伤时接受了相同技术的肘关节“三联征”损伤重建手术。平均随访时间为 25 个月（范围15 - 48 个月）。
84%的患者非常满意或满意。平均屈曲角度为 131 度（110 - 140 度）。平均伸展角度为 -11 度（-30 - 0 度）。平均旋前角度为 7 2 度（40 - 80 度）。平均旋后角度为 70 度（50 - 80 度）。握力平均为健侧的 75%（50 - 105%）。所有肘关节在复查时均稳定。发生了 8 例并发症。
我们的结果表明，一些肘关节“三联征”损伤可以通过外侧入路“由深至浅”稳定化成功治疗，包括使用可吸收锚钉进行前关节囊重新缝合实现三维稳定、桡骨头置换和外侧副韧带修复。这种标准治疗方法提供了足够的稳定性，允许早期积极康复，预防术后不稳定和僵硬。该手术似乎可靠且可重复。
