Afifi Ahmed, Lymona Ahmed M, Galal Sherif
Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, 11559 Egypt.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY USA.
Indian J Orthop. 2020 Mar 19;54(Suppl 2):254-259. doi: 10.1007/s43465-020-00090-x. eCollection 2020 Dec.
The combination of posterior elbow dislocation, radial head fracture, and coronoid fracture has been named "terrible triad" as this injury is difficult to treat and yield poor outcomes. Some studies compared the results of radial head fixation to replacement in isolated radial head fractures, very few reports have tried to compare both treatment modalities in the setting of a terrible triad injury.The aim of this study was to compare the functional outcome of radial head fixation vs replacement in terrible triad injuries of the elbow.
A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from April 2016 to April 2019.A total of 30 patients with terrible triad injury of the elbow were enrolled. The primary outcome was the Quick Disability of Arm, Shoulder and Hand (Quick-DASH) at 1 year. The secondary outcomes were to report the Mayo Elbow Performance Score (MEPS) at 1 year and elbow range of motion.
At final follow up for each patient (13.4 ± 1.2 months) The Quick-DASH score at 1 year for fixation group was 5 ± 2.3, for the replacement group it was 7.1 ± 7.1. The MEPS at 1 year for fixation group was 93.6 ± 8.4, for the replacement group it was 90.9 ± 9.4.Loss of elbow extension at 1 year for fixation group was 17.1° ± 10.7°, for replacement group it was 18.75° ± 11.5°.
A systematic approach to address the bony and soft tissue components of terrible triad elbow injury is crucial to obtain satisfactory outcome. Our study shows that radial head repair and replacement, in the setting of terrible triad injury, yields comparable results.
Level II, Therapeutic study.
肘关节后脱位、桡骨头骨折和冠突骨折同时存在被称为“恐怖三联征”，因为这种损伤治疗困难且预后不佳。一些研究比较了单纯桡骨头骨折时桡骨头固定与置换的结果，很少有报告尝试在恐怖三联征损伤的情况下比较这两种治疗方式。本研究的目的是比较恐怖三联征损伤时桡骨头固定与置换的功能结局。
2016年4月至2019年4月在一所一级学术创伤中心进行了一项单中心前瞻性队列研究。共纳入30例肘关节恐怖三联征损伤患者。主要结局是1年时的手臂、肩部和手部快速残疾量表（Quick-DASH）评分。次要结局是报告1年时的梅奥肘关节功能评分（MEPS）和肘关节活动范围。
在对每位患者的最终随访时（13.4±1.2个月），固定组1年时的Quick-DASH评分为5±2.3，置换组为7.1±7.1。固定组1年时的MEPS为93.6±8.4，置换组为90.9±9.4。固定组1年时肘关节伸展丧失为17.1°±10.7°，置换组为18.75°±11.5°。
采用系统方法处理恐怖三联征肘关节损伤的骨和软组织成分对于获得满意的结果至关重要。我们的研究表明，在恐怖三联征损伤情况下，桡骨头修复和置换产生的结果相当。
二级，治疗性研究。
