Treatment of elbow's terrible triad with anterior capsule repair: comparison of open reduction internal fixation versus radial head resection

Abstract

Terrible triad is described as dislocation of elbow associated with radial head and coronoid process fracture. Terrible triad injury results in 4 % of all radial head fractures and 31 % of elbow dislocations in adults. Regarding to various and prevalent complications due to this injury, controversies in management of this injury and shortage of some technical hardware such as radial head prosthesis in our country, we decided to perform this study and compare the results of two different therapeutic methods and determine whether one of them is more favorable. Methods: In this analytical cross-sectional study, 48 patients with Terrible triad injury whom had referred to Educational Therapeutic center of Shohada between September 2015 and September 2016, were divided into one of two treatment groups (Radial head and neck resection vs radial head and neck fixation). All patients were evaluated for final ROM and elbow stability at the end of 6th month of follow up. Mayo questionnaire scores were measured at the end of 6th month. Results: Thirty three (68.8%) were in fixation and 15 (31.2%) were in resection group. Mean age was 37.52 ± 13.03 years old and 35 patients (72.9%) were male. Range of flexion was similar in two groups. Average range of Extension was significantly lower and range of supination and pronation were higher in resection group. Post-op complication and reoperation rate were more prevalent in fixation group but the difference was not statistically significant. There was a significant positive correlation between Mayo score and flexion, pronation and supination ranges.