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New inside-outside technique for ‘terrible triad’ elbow injuries is reliable and reproducible
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NEW ORLEANS — The results of a series of 13 patients who underwent a new technique for reconstruction of “terrible triad” elbow injuries were described at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons, here.
The terrible triad of the elbow, which is notoriously difficult to treat due to the combined sagittal, frontal and transverse instability, is the combination of an elbow dislocation, radial head fracture and a coronoid process fracture, according to the abstract.
Christopher R. Chuinard, MD, told the audience, “We wanted an approach that would allow early range of motion and ideally would provide us with reliable and reproducible results.”
Technique and postoperative management
Chuinard described the technique as “an inside-outside technique or deep-to-superficial stabilization” that utilized a single, lateral approach, followed by capsular reinsertion with absorbable anchors, radial head replacement and lateral collateral ligament repair.
Postoperatively, “the patients were mobilized in a mobilizer that would allow early motion, stabilizing the arm to the body and the wrist to the body as well but allowing the patient to control range of motion,” Chuinard said. “The patients were provided with an axillary pain catheter and were allowed this early active motion on postoperative day one.”
Follow-up
Regarding patient satisfaction, Chuinard said, “Ten patients were essentially very satisfied, we had two that were moderately satisfied, and there was one patient that was not happy.”
According to the abstract, all elbows were stable at average follow-up of 25 months, and radiographs demonstrated good congruity of the humeroulnar and radiocapitellar joints.
Chuinard concluded, “This approach allows early active patient-controlled range of motion, essentially creating dynamic stability of the rotation; and by allowing early active motion we are able to minimize postoperative stiffness or the potential for it.”
- Reference:
Cikes A, Winder M, Chuinard C, Pelegri C. Surgical management of elbow dislocation associated with non-reparable fractures of the radial head. Paper 53. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13. New Orleans.
Chuinard is on the speaker bureau Mitek, and he is a paid consultant or employee of Mitek and TORNIER.
