Kim Beom-Soo, Kim Du-Han, Byun Seok-Ho, Cho Chul-Hyun
Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, 1035 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea.
J Clin Med. 2020 Oct 29;9(11):3500. doi: 10.3390/jcm9113500.
The purpose of this study was to investigate mid-term outcomes and complications after operative treatment according to a standardized protocol for terrible triad injuries. Twenty-four patients that were treated by a single surgeon with a standardized surgical protocol were retrospectively reviewed. After the complete reconstruction of radial head and/or lateral collateral ligament (LCL) complex through a lateral approach, coronoid process, and/or medial collateral ligament (MCL) complex through a medial approach were fixed if the elbow is unstable. For coronoid fractures, only type III were fixed in four cases (16.7%). Twenty-two LCL (91.7%) and five MCL (20.8%) complexes were repaired. At the final follow-up, the mean MEPS and Quick-DASH score were 91.5 and 17.3, respectively. There was no recurrent instability after operation in all cases. This study revealed that operative treatment that was based on our standardized protocol for terrible triad injuries yielded satisfactory mid-term clinical and radiographic outcomes without any recurrent instability. These results suggest that Type I and II coronoid fractures in terrible triad injuries do not need to be fixed if the radial head and ligamentous complex are completely reconstructed.
本研究的目的是根据严重三联损伤的标准化方案，调查手术治疗后的中期结果和并发症。回顾性分析了24例由单一外科医生采用标准化手术方案治疗的患者。通过外侧入路完成桡骨头和/或外侧副韧带（LCL）复合体的完全重建后，如果肘关节不稳定，则通过内侧入路固定冠突和/或内侧副韧带（MCL）复合体。对于冠突骨折，仅4例（16.7%）固定了III型骨折。修复了22条LCL（91.7%）和5条MCL（20.8%）复合体。在末次随访时，平均MEPS和Quick-DASH评分分别为91.5和17.3。所有病例术后均无复发性不稳定。本研究表明，基于我们的严重三联损伤标准化方案的手术治疗产生了令人满意的中期临床和影像学结果，且无任何复发性不稳定。这些结果表明，如果桡骨头和韧带复合体完全重建，严重三联损伤中的I型和II型冠突骨折无需固定。
