Short-term effectiveness of free radial head reconstruction of coronoid process combined with artificial radial head replacement in treatment of complex terrible triad of elbow_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Tao ^1,2 ,  MA Xinlong ³ , MA Jianxiong ³ , YU Runze ² , YU Defu ²

1. Postgraduate Institute, Tianjin Medical University, Tianjin, 300070, P.R.China;
2. Department of Orthopaedics, Anhui No.2 Provincal People’s Hospital, Hefei Anhui, 230041, P.R.China;
3. Institute of Orthopedics, Tianjin Hospital, Tianjin, 300211, P.R.China;

Corresponding author：

MA Xinlong, Email: tjmxl2017@sina.com

Keywords：

Terrible triad of the elbow; free radial head fragment; coronal process reconstruction; radial head replacement

DOI：

10.7507/1002-1892.202009081

Video：

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Objective To investigate the short-term effectiveness of free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation in the treatment of the complex terrible triad of the elbow.Methods Retrospective analysis was made on the clinical data of 12 patients with complex terrible triad of the elbow treated with free radial head reconstruction of coronoid process, artificial radial head replacement, and ulna olecranon internal fixation between April 2011 and April 2018. There were 8 males and 4 females with an average age of 44.5 years (range, 26-62 years). The causes of injury included 5 cases of traffic accident, 7 cases of falling from hight. The Regan-Morrey classification of ulnar coronoid process fractures was type Ⅲ; Mason classification of radial head fractures was type Ⅲ in 7 cases and type Ⅳ in 5 cases. The time from injury to operation was 5-14 days, with an average of 6.0 days. The operation time, intraoperative blood loss, and complications were recorded. After operation, X-ray film of elbow joint was reexamined, fracture healing condition was observed, and fracture healing time was recorded. The flexion, extension, and rotation of the elbow joints on the healthy and affected sides were recorded and measured. The elbow function was evaluated according to Mayo elbow function score.Results The operation time was 90-140 minutes (mean, 110 minutes); the intraoperative blood loss was 100-300 mL (mean, 150 mL). None of the patients had vascular injury during the operation. One patient developed numbness in the ulnar nerve innervation area and recovered completely after symptomatic treatment for 1 week. All the 12 patients were followed up 12-22 months, with an average of 16 months. At last follow-up, the fracture healed completely, 1 patient developed ectopic ossification of elbow joint, and 2 patients developed traumatic arthritis of elbow joint. No internal fixation-related complications occurred. There was no significant difference in the range of motion of elbow flexion, extension, pronation, and supination between the affected and healthy sides (P>0.05). The median Mayo elbow function score was 96, and the interquartile range was (94, 97), and the excellent and good rate was 91.7%.Conclusion For patients with complex terrible triad of the elbow with ulna coronoid process fractures of Regan-Morrey type Ⅲ and radial head fractures of Mason type Ⅲ, Ⅳ combined with ulna olecranon fractures, the free radial head reconstruction, artificial radial head replacement, and ulna olecranon internal fixation, through active rehabilitation function exercise after operation, can achieve more satisfactory short-term effectiveness.

Citation： CHEN Tao, MA Xinlong, MA Jianxiong, YU Runze, YU Defu. Short-term effectiveness of free radial head reconstruction of coronoid process combined with artificial radial head replacement in treatment of complex terrible triad of elbow. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 139-143. doi: 10.7507/1002-1892.202009081 Copy

1.	Kani KK, Chew FS. Terrible triad injuries of the elbow. Emerg Radiol, 2019, 26(3): 341-347.
2.	Li S, Li X, Lu Y. Analysis of radial head and coronoid process fractures in terrible triad of elbow. Eur J Orthop Surg Traumatol, 2019, 29(4): 775-784.
3.	肖刻, 张嘉, 李涛, 等. 肘关节 “恐怖三联征” 的解剖、治疗及其命名合理性的探讨. 中华骨科杂志, 2015, 35(7): 781-786.
4.	Liu G, Hu J, Ma W, et al. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach. J Int Med Res, 2018, 46(8): 3053-3064.
5.	Álvarez Muñoz M, Pardo García JM, García Lamas L, et al. Protocolised surgical treatment of terrible triad of elbow. Results and complications. Rev Esp Cir Ortop Traumatol, 2019, 63(4): 281-288.
6.	Cusick MC, Bonnaig NS, Azar FM, et al. Accuracy and reliability of the Mayo Elbow Performance Score. J Hand Surg (Am), 2014, 39(6): 1146-1150.
7.	Galbiatti JA, Cardoso FL, Ferro JA, et al. Terrible triad of the elbow: evaluation of surgical treatment. Rev Bras Ortop, 2018, 53(4): 460-466.
8.	Jung SW, Kim DH, Kang SH, et al. Risk factors that influence subsequent recurrent instability in terrible triad injury of the elbow. J Orthop Trauma, 2019, 33(5): 250-255.
9.	公茂琪, 蒋协远. 肘关节损伤三联征的治疗. 中华骨科杂志, 2018, 38(1): 60-64.
10.	王华松, 吴刚, 刘曦明, 等. 肘前入路微型钢板内固定治疗尺骨冠状突骨折. 中华创伤杂志, 2018, 34(4): 345-350.
11.	Antoni M, Eichler D, Kempf JF, et al. Anterior capsule re-attachment in terrible triad elbow injury with coronoid tip fracture. Orthop Traumatol Surg Res, 2019, 105(8): 1575-1583.
12.	Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg (Am), 1989, 71(9): 1348-1354.
13.	向明, 杨国勇, 胡晓川, 等. 肘关节前方血管神经间入路治疗尺骨冠状突骨折的中期研究. 中华骨科杂志, 2018, 38(1): 8-15.
14.	朱刃, 周均明, 赵兴, 等. 改良肘关节前侧入路治疗尺骨冠状突骨折. 中华创伤杂志, 2015, 31(5): 331-334.
15.	Ring D, Guss D, Jupiter JB. Reconstruction of the coronoid process using a fragment of discarded radial head. J Hand Surg (Am), 2012, 37(3): 570-574.
16.	Moritomo H, Tada K, Yoshida T, et al. Reconstruction of the coronoid for chronic dislocation of the elbow. J Bone Joint Surg (Br), 1998, 80(3): 490-492.
17.	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.
18.	公茂琪, 黄晓文, 李国珅, 等. 单一外侧切口和内外侧双切口治疗肘关节三联征的对比研究. 中华创伤杂志, 2017, 33(5): 389-396.
19.	查晔军, 蒋协远, 公茂琪. 保守治疗无骨性阻挡的 Mason Ⅱ、Ⅲ 型桡骨头骨折的疗效. 中华骨科杂志, 2018, 38(1): 16-22.
20.	Klug A, Nagy A, Gramlich Y, et al. Surgical treatment of the radial head in terrible triad injuries of the elbow. Bone Joint J, 2020, 102-B(12): 1618-1619.
21.	Afifi A, Lymona AM, Galal S. Radial head fixation vs replacement in terrible triad: Preliminary results of a prospective cohort study with patient reported outcome. Indian J Orthop, 2020, 54(Suppl 2): 254-259.
22.	Mukka S, Sjöholm P, Perisynakis N, et al. Radial head arthroplasty for radial head fractures: a clinical and radiological comparison of monopolar and bipolar radial head arthroplasty at a mean follow-up of 6 years. Eur J Trauma Emerg Surg, 2020, 46(3): 565-572.

1. Kani KK, Chew FS. Terrible triad injuries of the elbow. Emerg Radiol, 2019, 26(3): 341-347.
2. Li S, Li X, Lu Y. Analysis of radial head and coronoid process fractures in terrible triad of elbow. Eur J Orthop Surg Traumatol, 2019, 29(4): 775-784.
3. 肖刻, 张嘉, 李涛, 等. 肘关节 “恐怖三联征” 的解剖、治疗及其命名合理性的探讨. 中华骨科杂志, 2015, 35(7): 781-786.
4. Liu G, Hu J, Ma W, et al. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach. J Int Med Res, 2018, 46(8): 3053-3064.
5. Álvarez Muñoz M, Pardo García JM, García Lamas L, et al. Protocolised surgical treatment of terrible triad of elbow. Results and complications. Rev Esp Cir Ortop Traumatol, 2019, 63(4): 281-288.
6. Cusick MC, Bonnaig NS, Azar FM, et al. Accuracy and reliability of the Mayo Elbow Performance Score. J Hand Surg (Am), 2014, 39(6): 1146-1150.
7. Galbiatti JA, Cardoso FL, Ferro JA, et al. Terrible triad of the elbow: evaluation of surgical treatment. Rev Bras Ortop, 2018, 53(4): 460-466.
8. Jung SW, Kim DH, Kang SH, et al. Risk factors that influence subsequent recurrent instability in terrible triad injury of the elbow. J Orthop Trauma, 2019, 33(5): 250-255.
9. 公茂琪, 蒋协远. 肘关节损伤三联征的治疗. 中华骨科杂志, 2018, 38(1): 60-64.
10. 王华松, 吴刚, 刘曦明, 等. 肘前入路微型钢板内固定治疗尺骨冠状突骨折. 中华创伤杂志, 2018, 34(4): 345-350.
11. Antoni M, Eichler D, Kempf JF, et al. Anterior capsule re-attachment in terrible triad elbow injury with coronoid tip fracture. Orthop Traumatol Surg Res, 2019, 105(8): 1575-1583.
12. Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg (Am), 1989, 71(9): 1348-1354.
13. 向明, 杨国勇, 胡晓川, 等. 肘关节前方血管神经间入路治疗尺骨冠状突骨折的中期研究. 中华骨科杂志, 2018, 38(1): 8-15.
14. 朱刃, 周均明, 赵兴, 等. 改良肘关节前侧入路治疗尺骨冠状突骨折. 中华创伤杂志, 2015, 31(5): 331-334.
15. Ring D, Guss D, Jupiter JB. Reconstruction of the coronoid process using a fragment of discarded radial head. J Hand Surg (Am), 2012, 37(3): 570-574.
16. Moritomo H, Tada K, Yoshida T, et al. Reconstruction of the coronoid for chronic dislocation of the elbow. J Bone Joint Surg (Br), 1998, 80(3): 490-492.
17. 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.
18. 公茂琪, 黄晓文, 李国珅, 等. 单一外侧切口和内外侧双切口治疗肘关节三联征的对比研究. 中华创伤杂志, 2017, 33(5): 389-396.
19. 查晔军, 蒋协远, 公茂琪. 保守治疗无骨性阻挡的 Mason Ⅱ、Ⅲ 型桡骨头骨折的疗效. 中华骨科杂志, 2018, 38(1): 16-22.
20. Klug A, Nagy A, Gramlich Y, et al. Surgical treatment of the radial head in terrible triad injuries of the elbow. Bone Joint J, 2020, 102-B(12): 1618-1619.
21. Afifi A, Lymona AM, Galal S. Radial head fixation vs replacement in terrible triad: Preliminary results of a prospective cohort study with patient reported outcome. Indian J Orthop, 2020, 54(Suppl 2): 254-259.
22. Mukka S, Sjöholm P, Perisynakis N, et al. Radial head arthroplasty for radial head fractures: a clinical and radiological comparison of monopolar and bipolar radial head arthroplasty at a mean follow-up of 6 years. Eur J Trauma Emerg Surg, 2020, 46(3): 565-572.

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Short-term effectiveness of free radial head reconstruction of coronoid process combined with artificial radial head replacement in treatment of complex terrible triad of elbow

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