Faqih Eman, Sawan Hasan, Alfadhel Shoog Fahad, AlAbbasi Khaled, Alrawi Mustafa
King Fahad Medical City, Riyadh, Saudi Arabia.
King Fahad Medical City, Riyadh, Saudi Arabia.
Int J Surg Case Rep. 2023 Nov;112:108912. doi: 10.1016/j.ijscr.2023.108912. Epub 2023 Oct 3.
The dislocation of the elbow joint to the posterior or postero-lateral region accompanied by fractures in the radial head or neck and coronoid process of the Ulna is known as a terrible triad injury of the elbow (TTI).
This injury presents as unique challenge for orthopedic surgeons due to elbow instability and stiffness, making the surgical intervention more difficult than usual.
A 47-year-old man suffered from polytrauma, including a pelvis fracture, a left humerus shaft fracture, and left ulna shaft fracture. An open reduction and internal fixation were administered as a treatment option. However, during a follow-up examination four months later, a missed fracture dislocation of the right elbow was discovered.
The complex surgery required open reduction of the chronic dislocated joint, release of the triceps, resection of the radial head, replacement, bone grafting of the coronoid, reconstruction of the coronoid, and application of a spanning external fixation. The injury was complex, consisting of coronoid fractures, olecranon, a proximal third of the Ulna, and radial head malunion with heterotrophic ossification around the elbow joint.
After seven years, our patient had a full range of motion in elbow flexion with 20-25 lags in extension. The Mayo Elbow Performance Score (MEPS) was 100 and Disabilities of Arm, Shoulder and Hand (DASH) score was 0.
肘关节向后或后外侧脱位并伴有桡骨头或颈部以及尺骨冠突骨折，被称为肘关节恐怖三联征损伤（TTI）。
由于肘关节不稳定和僵硬，这种损伤对骨科医生来说是一项独特的挑战，使得手术干预比平常更加困难。
一名47岁男性遭受多处创伤，包括骨盆骨折、左肱骨干骨折和左尺骨干骨折。采用切开复位内固定作为治疗选择。然而，在四个月后的随访检查中，发现右肘关节存在漏诊的骨折脱位。
复杂的手术需要对慢性脱位的关节进行切开复位、肱三头肌松解、桡骨头切除、置换、尺骨冠突植骨、冠突重建以及应用跨越外固定。损伤情况复杂，包括冠突骨折、鹰嘴骨折、尺骨近端三分之一骨折以及桡骨头畸形愈合并伴有肘关节周围异位骨化。
七年后，我们的患者肘关节屈曲活动范围正常，伸展时有20 - 25度的滞后。梅奥肘关节功能评分（MEPS）为100分，上肢、肩部和手部功能障碍评分（DASH）为0分。
