Ozdag Yagiz, Luciani A Michael, Delma Stephanie, Baylor Jessica L, Foster Brian K, Grandizio Louis C
Orthopaedics, Geisinger Medical Center, Danville, USA.
Orthopaedic Surgery, Geisinger Medical Center, Danville, USA.
Cureus. 2022 Jul 22;14(7):e27156. doi: 10.7759/cureus.27156. eCollection 2022 Jul.
To assess the outcomes of operatively treated terrible triad (TT) elbow injuries for a single surgeon at the start of clinical practice. We aimed to define postoperative patient reported outcome measures (PROMs), range of motion (ROM), and complications during the period immediately following fellowship training, in order to describe the learning process for surgical treatment of TT. Methods: All operatively treated TTs from 2017 to 2020 were included. All cases were performed by a single, fellowship-trained upper-extremity surgeon and represented a consecutive series at the start of clinical practice. Baseline demographics, injury characteristics, and surgical details were recorded for each case. PROMs [QuickDisability of arm, shoulder, and hand (DASH) and (visual analog scale) pain scale], ROM, and complications were recorded at the time of final follow-up. A perioperative glucocorticoid protocol was used in all cases without diabetes.
There was a total of 21 included TT cases with a mean follow-up of 20 months. The operative time averaged 89 min for the first 10 cases and 83 min for the subsequent 11 cases. The mean QuickDASH and VAS pain score at final follow-up were 19 and 2.3, respectively. The mean flexion-extension arc was 122° and two cases (9%) had < 100° arc of motion. The mean pronation-supination arc was 145°. Three cases (14%) had a postoperative complication, all of which underwent reoperation. Of the 21 included cases, these reoperations represented cases #1, #14, and #17 respectively. Conclusions: Upper-extremity surgeons at the start of clinical practice may be able to achieve outcomes similar to more experienced surgeons for operatively treated TT elbow fracture dislocations. There does not appear to be a substantial "learning curve" after fellowship training with respect to PROMs, complication rates, or operative time associated with surgical treatment of TT elbow injuries.
评估一名外科医生在临床实践初期手术治疗肘关节恐怖三联征（TT）的疗效。我们旨在确定 fellowship 培训后即刻的术后患者报告结局指标（PROMs）、活动范围（ROM）和并发症情况，以描述 TT 手术治疗的学习过程。方法：纳入 2017 年至 2020 年所有接受手术治疗的 TT 病例。所有病例均由一名接受过 fellowship 培训的上肢外科医生完成，且为临床实践初期的连续病例系列。记录每个病例的基线人口统计学资料、损伤特征和手术细节。在末次随访时记录 PROMs[手臂、肩部和手部快速残疾评定量表（DASH）和视觉模拟量表（VAS）疼痛量表]、ROM 和并发症情况。所有非糖尿病病例均采用围手术期糖皮质激素方案。结果：共纳入 21 例 TT 病例，平均随访 20 个月。前 10 例手术平均时间为 89 分钟，后 11 例为 83 分钟。末次随访时 QuickDASH 和 VAS 疼痛评分的平均值分别为 19 和 2.3。屈伸弧平均为 122°，2 例（9%）活动弧<100°。旋前旋后弧平均为 145°。3 例（14%）发生术后并发症，均接受了再次手术。在纳入的 21 例病例中，这些再次手术分别代表病例#1、#14 和#17。结论：临床实践初期的上肢外科医生在手术治疗 TT 型肘关节骨折脱位时，可能能够取得与经验更丰富的外科医生相似的疗效。在 fellowship 培训后，与 TT 型肘关节损伤手术治疗相关的 PROMs、并发症发生率或手术时间方面似乎不存在显著的“学习曲线”。
