Salwan Ankur, Saoji Amit, Pisulkar Gajanan, Awasthi Abhiram A, Taywade Shounak
Department of Orthopaedics and Traumatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.
Department of Orthopedics and Traumatology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND.
Cureus. 2023 Apr 25;15(4):e38119. doi: 10.7759/cureus.38119. eCollection 2023 Apr.
The terrible triad (TT) of the elbow consists of coronoid process (CP) fracture, fracture of the radial head (RH), and posterior dislocation. Although the coronoid is an important anterior stabilizer, it is still unclear how to treat comminuted coronoid fractures. Poor fixation of the CP tends to result in posterolateral instability at the elbow joint and often in chronic instability. The ligamentous injuries also cause instability in elbow dislocations and should be suspected. There are various techniques available for coronoid fracture fixation. In this case report, we want to highlight our experience managing a 47-year-old male with posterior dislocation of the elbow after computed tomography (CT) confirmed that the patient had an RH fracture with an avulsion fracture of the coronoid. This TT of the elbow was managed with the help of an endobutton and a Herbert screw for coronoid avulsion fracture and RH fracture, respectively, through a lateral (Kocher) approach in our tertiary care hospital with satisfactory results. The use of endobutton is recommended in type 1 and type 2 coronoid fractures with no or minimal capsular attachment for good suspensory effect, and it emphasizes the possibility of associated coronoid fracture in case of posterior elbow dislocation. This case report emphasizes the fixation of even small fragments of the coronoid fracture for better stability and early mobilization. Postoperative rehabilitation involved using a hinged brace and early mobilization to avoid a stiff elbow and periodic X-rays to check the heterotopic ossification risk.
肘关节的可怕三联征（TT）包括冠状突骨折、桡骨头骨折和后脱位。尽管冠状突是重要的前侧稳定结构，但对于粉碎性冠状突骨折的治疗方法仍不明确。冠状突固定不佳往往会导致肘关节后外侧不稳定，并常常引发慢性不稳定。韧带损伤也会导致肘关节脱位时的不稳定，应予以怀疑。有多种冠状突骨折固定技术。在本病例报告中，我们想分享我们治疗一名47岁男性患者的经验，该患者经计算机断层扫描（CT）证实为肘关节后脱位，同时伴有桡骨头骨折和冠状突撕脱骨折。在我们的三级护理医院，通过外侧（Kocher）入路，分别使用纽扣钢板和Herbert螺钉对冠状突撕脱骨折和桡骨头骨折进行处理，取得了满意的效果。对于1型和2型冠状突骨折，若没有或仅有极少的关节囊附着，推荐使用纽扣钢板以获得良好的悬吊效果，并且强调了肘关节后脱位时存在冠状突骨折的可能性。本病例报告强调，即使是冠状突骨折的小碎片也应进行固定，以实现更好的稳定性和早期活动。术后康复包括使用铰链支具并尽早活动，以避免肘关节僵硬，并定期进行X线检查以评估异位骨化风险。
