Service d'orthopédie-traumatologie, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51100 Reims, France.
Service d'orthopédie-traumatologie, hôpital Maison-Blanche, 45, rue Cognacq-Jay, 51100 Reims, France.
Orthop Traumatol Surg Res. 2021 Feb;107(1S):102784. doi: 10.1016/j.otsr.2020.102784. Epub 2021 Jan 9.
Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. It is a complex trauma, associating severe bone and ligament lesions, with high more-or-less long-term risk of residual instability, stiffness, pain and osteoarthritis. During the last 20 years, pathologic, biomechanical and clinical knowledge has greatly progressed. Prevention of these severe complications requires initial understanding of the lesion mechanism and precise analysis of all lesions. Surgery aims to restore perfect stability by sequential anatomic repair, enabling early mobilization to prevent onset of stiffness. The aims of the present paper were to summarize the anatomic and pathophysiological bases, highlight the crucial importance of the humeroradial column and lateral collateral ligament, and to determine the importance of the coronoid process. Some aspects of treatment are controversial: systematic medial collateral ligament repair, or use of an articulated external fixator. Finally, we propose a simple algorithm to guide repair.
肘的三联征包括后脱位、桡骨头骨折和冠状突骨折。它是一种复杂的创伤，伴有严重的骨和韧带损伤，或多或少存在长期残留不稳定、僵硬、疼痛和骨关节炎的高风险。在过去的 20 年中，病理、生物力学和临床知识有了很大的进展。预防这些严重并发症需要初步了解损伤机制，并对所有损伤进行精确分析。手术的目的是通过连续的解剖修复来恢复完美的稳定性，从而实现早期活动以防止发生僵硬。本文的目的是总结解剖和病理生理基础，强调肱桡柱和外侧侧副韧带的重要性，并确定冠状突的重要性。治疗的某些方面存在争议：是否系统修复内侧副韧带，或使用关节外固定器。最后，我们提出了一个简单的算法来指导修复。
