'The treatable triad' long-term functional results of surgically treated acute isolated terrible triad injuries: an 18-year follow-up.

BACKGROUND

Surgical techniques for terrible triad injuries developed 20 years ago. Good and excellent short- and medium-term functional results have been reported. No long-term (over 10 years) functional outcomes have previously been reported. This case-series is the longest follow-up of patients treated for acute isolated terrible triad injuries using a standard treatment protocol.

METHODS

Twenty patients with acute, isolated, surgically managed terrible triad injuries were treated between October 2001 and May 2008. Ten of these patients were seen face-to face for a clinical follow-up and if required a radiological assessment. Mayo Elbow Performance Scores (MEPSs) and Disabilities of the Arm, Shoulder and Hand (DASH) scores, requirement for further surgery and elbow instability were recorded.

RESULTS

The average length of follow-up was 18.8 years. The mean Mayo Elbow Performance Score was 88 and the mean Disability of the Arm, Shoulder and Hand score was 12.3. The average loss of pronation was 8°. The average loss of supination was 13°. The reoperation rate was 40%, only one of these was a functionally limiting operation. A trend toward osteoarthritis was observed but there were no conversions to total elbow replacement.

DISCUSSION

This is the longest-term follow-up study of these injuries and demonstrates the functional performance that the majority of patients achieve. The low follow-up rate can be expected with such a long interval between treatment and assessment. A relatively high reoperation rate is largely made up of minor procedures (removal of metalwork and cubital tunnel release) which did not impact the patients' functional status. This study adds to the evidence that the terrible triad of the elbow is surgically treatable to allow a high functional standard not only in the short-term but also in the long term. As such this is a useful adjunct to have both when informing patients of what can be expected in their long-term recovery from this injury.