Evaluation of the effect of anterior median approach combined with lateral approach in the treatment of terrible triad of the elbow_West China Medical Journal

Authors：

LI Yuanli ,  WEI Peng , DENG Chunbiao , NIE Junlan , YANG Xin , JIANG Ping

Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 643000, P. R. China;

Corresponding author：

WEI Peng, Email: weipeng789@vip.163.com

Keywords：

Anterior median approach of the elbow joint combined with the lateral approach; Medial and lateral approach of the elbow joint; Terrible triad of the elbow joint; Radial head fracture; Coronal process fracture

DOI：

10.7507/1002-0179.202008102

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Objective To explore the clinical significance of anterior median approach combined with lateral approach to the elbow joint in the treatment of terrible triad of the elbow.Methods We retrospectively collected the data of 63 cases who used the anterior median approach of the elbow joint combined with the lateral approach (group A, n=36) or the medial and lateral approach of the elbow (group B, n=27) in the treatment of terrible triad of the elbow between March 2014 and July 2019. The operation time, postoperative complications, and postoperative Mayo score of the elbow were compared between the two surgical approaches.Results The operation time of group A and group B was (93.78±7.78) and (106.93±10.35) min, respectively, and the difference was statistically significant (P<0.05). The patients in both groups completed operations successfully, without vascular or nerve injury. All the wounds healed by first intention. No redislocation or reoperation occurred. Ten months after operation, there was no significant difference in the excellence rate of Mayo score of the elbow (83.3% vs. 85.2%) or postoperative complication rate (16.7% vs. 14.8%) between the two groups (P>0.05).Conclusion The anterior median approach of the elbow joint combined with the lateral approach and the medial and lateral elbow approach for the treatment of terrible triad of the elbow are equivalent to the postoperative elbow function recovery. The operation time of the former is shorter than that of the latter, and the anterior approach reveals the coronal process intuitively and sufficiently. In the case that there is no medial ligament injury, the anterior median approach of the elbow joint combined with the lateral approach can be preferred.

Citation： LI Yuanli, WEI Peng, DENG Chunbiao, NIE Junlan, YANG Xin, JIANG Ping. Evaluation of the effect of anterior median approach combined with lateral approach in the treatment of terrible triad of the elbow. West China Medical Journal, 2020, 35(10): 1185-1188. doi: 10.7507/1002-0179.202008102 Copy

1.	Hotchkiss RN. Fractures and dislocations of the elbow// Rockwood CA Jr, Green DP, Bucholz RW, et al. Rockwood and Green’s fractures in adults: Volume I. 4th ed. Philadelphia, PA: Lippincott-Raven, 1996: 929-1024.
2.	Rodriguez-Martin J, Pretell-Mazzini J, Andres-Esteban EM, et al. Outcomes after terrible triads of the elbow treated with the current surgical protocols. A review. Int Orthop, 2011, 35(6): 851-860.
3.	Chan K, MacDermid JC, Faber KJ, et al. Can we treat select terrible triad injuries nonoperatively?. Clin Orthop Relat Res, 2014, 472(7): 2092-2099.
4.	Mathew PK, Athwal GS, Gj K. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009, 17(3): 137-151.
5.	Chen HW, Liu GD, Wu LJ. Complications of treating terrible triad injury of the elbow: a systematic review. PLoS One, 2014, 9(5): e97476.
6.	于连祥, 丁晓琳, 刘庆鹏, 等. 影响肘关节恐怖三联征治疗效果的因素分析. 中国矫形外科杂志, 2013, 21(12): 1190-1194.
7.	孟亚轲, 刘岩, 叶添文, 等. 肘关节“恐怖三联征”的手术治疗: 附 14 例报告. 中华肩肘外科电子杂志, 2015, 3(3): 151-155.
8.	Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg, 1954, 42(172): 123-132.
9.	Regan W, Morrey B. Fractures of the coronoid process of ulna. J Bone Joint Surg Am, 1989, 71(9): 1348-1354.
10.	查晔军, 蒋协远, 公茂琪, 等. 组配型桡骨头假体置换治疗桡骨头粉碎性骨折. 中华创伤骨科杂志, 2012, 14(4): 288-294.
11.	Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am, 2002, 84-A(4): 547-551.
12.	Pugh DM, Wild LM, Schemitsch EH, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am, 2004, 86-A(6): 1122-1130.
13.	Schneeberger AG, Sadowski MM, Jacob HA. Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am, 2004, 86(5): 975-982.
14.	Pomianowski S, Morrey BF, Neale PG, et al. Contribution of monoblock and bipolar radial head prostheses to valgus stability of the elbow. J Bone Joint Surg Am, 2001, 83(12): 1829-1834.
15.	童鹭华, 汪根和, 叶华明. 外内侧联合入路手术治疗肘关节恐怖三联征. 赣南医学院学报, 2018, 38(3): 250-252.
16.	周超. 手术治疗肘关节恐怖三联征. 临床骨科杂志, 2016, 19(1): 110.

1. Hotchkiss RN. Fractures and dislocations of the elbow// Rockwood CA Jr, Green DP, Bucholz RW, et al. Rockwood and Green’s fractures in adults: Volume I. 4th ed. Philadelphia, PA: Lippincott-Raven, 1996: 929-1024.
2. Rodriguez-Martin J, Pretell-Mazzini J, Andres-Esteban EM, et al. Outcomes after terrible triads of the elbow treated with the current surgical protocols. A review. Int Orthop, 2011, 35(6): 851-860.
3. Chan K, MacDermid JC, Faber KJ, et al. Can we treat select terrible triad injuries nonoperatively?. Clin Orthop Relat Res, 2014, 472(7): 2092-2099.
4. Mathew PK, Athwal GS, Gj K. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009, 17(3): 137-151.
5. Chen HW, Liu GD, Wu LJ. Complications of treating terrible triad injury of the elbow: a systematic review. PLoS One, 2014, 9(5): e97476.
6. 于连祥, 丁晓琳, 刘庆鹏, 等. 影响肘关节恐怖三联征治疗效果的因素分析. 中国矫形外科杂志, 2013, 21(12): 1190-1194.
7. 孟亚轲, 刘岩, 叶添文, 等. 肘关节“恐怖三联征”的手术治疗: 附 14 例报告. 中华肩肘外科电子杂志, 2015, 3(3): 151-155.
8. Mason ML. Some observations on fractures of the head of the radius with a review of one hundred cases. Br J Surg, 1954, 42(172): 123-132.
9. Regan W, Morrey B. Fractures of the coronoid process of ulna. J Bone Joint Surg Am, 1989, 71(9): 1348-1354.
10. 查晔军, 蒋协远, 公茂琪, 等. 组配型桡骨头假体置换治疗桡骨头粉碎性骨折. 中华创伤骨科杂志, 2012, 14(4): 288-294.
11. Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am, 2002, 84-A(4): 547-551.
12. Pugh DM, Wild LM, Schemitsch EH, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am, 2004, 86-A(6): 1122-1130.
13. Schneeberger AG, Sadowski MM, Jacob HA. Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am, 2004, 86(5): 975-982.
14. Pomianowski S, Morrey BF, Neale PG, et al. Contribution of monoblock and bipolar radial head prostheses to valgus stability of the elbow. J Bone Joint Surg Am, 2001, 83(12): 1829-1834.
15. 童鹭华, 汪根和, 叶华明. 外内侧联合入路手术治疗肘关节恐怖三联征. 赣南医学院学报, 2018, 38(3): 250-252.
16. 周超. 手术治疗肘关节恐怖三联征. 临床骨科杂志, 2016, 19(1): 110.

West China Medical Journal

Evaluation of the effect of anterior median approach combined with lateral approach in the treatment of terrible triad of the elbow

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