Department of Trauma and Orthopaedic Surgery, BG Unfallklinik Frankfurt am Main, Friedberger Landstrasse 430, 60389, Frankfurt, Germany.
Arch Orthop Trauma Surg. 2023 Aug;143(8):5055-5064. doi: 10.1007/s00402-023-04889-9. Epub 2023 Apr 26.
The optimal treatment of terrible triad injuries of the elbow (TTI) remains topic of ongoing discussion. The aim of this study was to determine whether different treatment strategies for coronoid tip fractures in terrible triad injuries influences the clinical and radiological results in a mid-term follow-up.
A total of 62 patients with surgical treatment of a TTI including a coronoid tip fracture (37 women, 25 men; mean age, 51 years) were available for follow-up assessment after an average of 4.2 years (range 24-110 months). Thirteen patients had O'Driscoll 1.1 and 49 O'Driscoll 1.2 coronoid fractures, of which 26 were treated with and 36 without fixation. Range of motion, the Mayo Elbow Performance Score (MEPS), Oxford Elbow Score (OES), and Disabilities of the Arm, Shoulder and Hand (DASH) score as well as grip strength were evaluated. Radiographs were analyzed for all participants.
No significant benefit in outcome variables could be detected between patients, whose coronoid had been fixed, compared to patients without fixation of the coronoid. In the coronoid fixation group, patients had mean outcome scores of 81.5 ± SD 19.1 (range 35-100) for MEPS, 31.0 ± SD 12.5 (range 11-48) for OES and 27.7 ± SD 23 (range 0-61) for DASH score, while in the no-fixation group, mean MEPS was 90.8 ± SD 16.5 (range 40-100), mean OES was 39.0 ± SD 10.4 (range 16-48) and mean DASH score was 14.5 ± SD 19.9 (range 0-48). Mean range of motion was 116° ± SD 21° (range 85-140°) versus 124° ± SD 24° (range 80-150°) in extension-flexion and 158° ± SD 23° (range 70-180°) versus 165° ± SD 12° (range 85-180°) in pronation-supination. Overall complication rate was 43.5% and revision rate was 24.2%, with no significant differences between both groups. Suboptimal results were more frequently seen in patients who had degenerative or heterotopic changes on their latest radiograph.
Sufficient elbow stability and good outcomes can be achieved in most patients with TTI and coronoid tip fractures. Although some bias in treatment allocation and group heterogeneity cannot be completely omitted, our analysis detected no significant benefit in outcome when the coronoid tip fracture has been fixed compared to patients with non-fixed coronoid tip. Therefore, we would suggest a no-fixation approach for coronoid tip fractures as primary treatment in TTI of the elbow.
Level III, retrospective comparative study.
肘部三联征损伤（TTI）的最佳治疗方法仍在讨论中。本研究的目的是确定 TTl 中冠状突尖端骨折的不同治疗策略是否会影响中期随访的临床和影像学结果。
共纳入 62 例接受手术治疗的 TTI 患者（37 名女性，25 名男性；平均年龄 51 岁），平均随访 4.2 年（24-110 个月）。13 例为 O'Driscoll 1.1 型，49 例为 O'Driscoll 1.2 型冠状突骨折，其中 26 例行固定治疗，36 例行非固定治疗。评估范围活动度、 Mayo 肘功能评分（MEPS）、牛津肘评分（OES）、残疾程度的手臂，肩部和手（DASH）评分以及握力。对所有参与者进行 X 线分析。
与未固定冠状突的患者相比，固定冠状突的患者在预后变量方面没有明显的获益。在冠状突固定组中，患者 MEPS 的平均评分为 81.5 ± 19.1（范围 35-100），OES 为 31.0 ± 12.5（范围 11-48），DASH 为 27.7 ± 23（范围 0-61），而非固定组的 MEPS 平均为 90.8 ± 16.5（范围 40-100），OES 平均为 39.0 ± 10.4（范围 16-48），DASH 平均为 14.5 ± 19.9（范围 0-48）。屈伸活动度平均为 116°±21°（范围 85-140°）与 124°±24°（范围 80-150°），旋前旋后活动度平均为 158°±23°（范围 70-180°）与 165°±12°（范围 85-180°）。总体并发症发生率为 43.5%，翻修率为 24.2%，两组间无显著差异。在最近的 X 线片上出现退行性或异位改变的患者更常出现结果不理想。
大多数肘部三联征损伤合并冠状突尖端骨折的患者可获得足够的肘部稳定性和良好的结果。尽管在治疗分配和组间异质性方面存在一定的偏倚，但我们的分析并未发现冠状突尖端骨折固定与非固定患者的预后有显著改善。因此，我们建议在肘部三联征损伤中，冠状突尖端骨折采用非固定方法作为主要治疗方法。
III 级，回顾性比较研究。
