Gavaskar Ashok S, Tummala Naveen C, Srinivasan Parthasarathy, Ayyadurai Prakash, Ca Ashwath, Chand Bharath
Rela Institute and Medical Centre, Chennai, India.
Swaram Hospital, Chennai, India.
JSES Int. 2025 Feb 15;9(3):912-919. doi: 10.1016/j.jseint.2025.01.019. eCollection 2025 May.
Terrible triad (TT) of the elbow and olecranon fracture dislocation (OFD) injuries are a combination of 2 different types of unstable fracture dislocation injuries classified under traumatic elbow instability patterns. Despite the differences in injury mechanisms, similarities in the structures disrupted and treatment principles make it meaningful to compare outcomes and complications after surgical treatment of these injuries.
We reviewed data of 91 patients who underwent surgical treatment for TT injuries and olecranon fracture dislocations and were assessed for inclusion during the study period between 2012 and 2021. After exclusions, 79 patients (TT: 44; olecranon fracture dislocations: 35) were included for analysis. Elbow and forearm range of motion, joint stability, and other procedure and injury-related complications were assessed and compared at a mean follow-up of 49 ± 18 months. Functional outcome was analyzed using the Mayo Elbow Performance Score (MEPS); Oxford Elbow Score; and the Quick Disabilities of the Arm, Shoulder, and Hand scores.
Patients with TT had significantly better flexion-extension arc ( = .014) and less extension deficit ( < .001) but less supination ( < .001) compared to patients with OFDs. The functional outcome scores, incidence of complications and need for repeat surgeries were similar in both groups except for radiological evidence of elbow arthritis which was more common in the OFD group ( = .03). Eighty-four percent of patients in the TT group and 86% in the OFD group had good to excellent MEPS. Patients without complications also had better MEPS in both groups compared to patients with complications ( < .001).
Good-to-excellent functional outcome can be expected in majority of patients with TT and OFDs. Complications are common and can be expected in more than 40% of patients. Secondary surgical interventions may be needed in more than 25% of patients.
肘关节恐怖三联征（TT）和鹰嘴骨折脱位（OFD）损伤是创伤性肘关节不稳定类型中两种不同类型的不稳定骨折脱位损伤的组合。尽管损伤机制不同，但结构破坏和治疗原则的相似性使得比较这些损伤手术治疗后的结果和并发症具有意义。
我们回顾了91例接受TT损伤和鹰嘴骨折脱位手术治疗的患者的数据，并在2012年至2021年的研究期间对其进行纳入评估。排除后，纳入79例患者（TT：44例；鹰嘴骨折脱位：35例）进行分析。在平均随访49±18个月时，评估并比较肘关节和前臂的活动范围、关节稳定性以及其他与手术和损伤相关的并发症。使用梅奥肘关节功能评分（MEPS）、牛津肘关节评分和手臂、肩部和手部快速残疾评分分析功能结果。
与OFD患者相比，TT患者的屈伸弧明显更好（P = 0.014），伸展受限更少（P < 0.001），但旋后更少（P < 0.001）。除肘关节关节炎放射学证据在OFD组更常见（P = 0.03）外，两组的功能结果评分、并发症发生率及再次手术需求相似。TT组84% 的患者和OFD组86% 的患者MEPS为良好至优秀。与有并发症的患者相比，两组中无并发症患者的MEPS也更好（P < 0.001）。
大多数TT 和OFD患者可预期获得良好至优秀功能结果。并发症很常见，超过40% 的患者可能出现。超过25% 的患者可能需要二次手术干预。
