Almalki Talal, AlMarshad Abdullah Y, Beidas Khalid, Alshurafa Khaled, Al Bassam Hamad
Security Forces Hospital Program, Department of Orthopedics, Riyadh, Saudi Arabia.
King Faisal Specialist Hospital and Research Centre, Department of Orthopedics, Riyadh, Saudi Arabia.
Int J Surg Case Rep. 2021 Feb;79:222-226. doi: 10.1016/j.ijscr.2021.01.024. Epub 2021 Jan 15.
Elbow dislocation is common in adults, and complex elbow dislocations are generally associated with bone fractures. Anteromedial coronoid fracture, in association with lateral collateral ligament (LCL) disruption, often results from varus posteromedial forces. "Terrible triad" injuries are more likely to result from valgus posterolateral forces. However, our case presentation has combined medial and lateral elbow instability in addition to "terrible triad" injury of the elbow with no radial head injury.
The patient was a 38-year-old man with an atypical complex elbow dislocation. He was successfully treated by stabilizing the medial epicondyle and coronoid anterolateral facet fractures, in addition to LCL repair and medial collateral ligament (MCL) reconstruction. A radial head fracture was unnoted. The procedure yielded satisfactory functional outcome, with a stable and painless full elbow range of motion.
Multi-ligament injuries with coronoid fractures result in highly unstable elbow joints, forming a variant of the "terrible triad" injury. Surgical options vary according to the surgeon's experience and equipment availability. In this case, direct LCL repair and MCL reconstruction were performed and were well tolerated. Elbow stability improved and the patient experienced improved functionality with minimal pain. However, it may be premature to report a definite outcome in this case because of short follow-up time postoperatively.
The injury described in this case has a unique presentation as a multi-ligamentous injury will make the elbow very unstable. Thus, careful clinical judgment, knowledge, and experience are needed to identify the underlying injury and for optimal management.
肘关节脱位在成年人中较为常见，复杂的肘关节脱位通常与骨折相关。冠状突前内侧骨折，伴有外侧副韧带（LCL）断裂，常由内翻后内侧暴力所致。“恐怖三联征”损伤多由外翻后外侧暴力引起。然而，我们的病例呈现出肘关节内侧和外侧不稳定，以及肘关节“恐怖三联征”损伤，且无桡骨头损伤。
患者为一名38岁男性，患有非典型复杂肘关节脱位。除了修复LCL和重建内侧副韧带（MCL）外，通过稳定内上髁和冠状突前外侧小关节面骨折，成功对其进行了治疗。未发现桡骨头骨折。该手术取得了满意的功能结果，肘关节活动范围稳定且无痛。
伴有冠状突骨折的多韧带损伤会导致肘关节高度不稳定，形成“恐怖三联征”损伤的一种变体。手术选择因外科医生的经验和设备可用性而异。在本病例中，进行了直接LCL修复和MCL重建，患者耐受性良好。肘关节稳定性得到改善，患者功能改善且疼痛轻微。然而，由于术后随访时间短，在本病例中报告明确结果可能为时过早。
本病例所描述的损伤具有独特的表现，因为多韧带损伤会使肘关节非常不稳定。因此，需要仔细的临床判断、知识和经验来识别潜在损伤并进行最佳管理。
