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Modified Pugh standard protocol yielded excellent outcomes of terrible triad elbow injuries
From 3 months postoperatively, functional results of the elbow improved, but they plateaued 1 year after surgery.
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Despite complications, surgical treatment of terrible triad injuries of the elbow that involve slight modifications of the Pugh standard surgical protocol may yield good to excellent outcomes, according to results published in Medicine.
Researchers evaluated elbow functional status among 42 patients with terrible triad injuries of the elbow at 3 months, 6 months, 1 year and 2 years or more after surgical treatment with a modified Pugh standard protocol. The researchers then rated radiographic signs of posttraumatic arthritis according to the Broberg and Morrey system.
Results showed patients had a mean flexion-extension arc of about 107°, and an average forearm rotation arc of about 145°. Researchers found the patients’ mean Mayo Elbow Performance Score was about 88 points. Excellent, good and poor Mayo Elbow Performance Score results were found in 24 patients, 16 patients and 2 patients, respectively, according to the study results.
Although researchers noted in their study there were significant improvements in functional elbow results from 3 months postoperatively, these results tended to plateau from 1 year after surgery, they said.
Researchers found mean range of movement increased from 90° to 106° for flexion extension arc and from 131° to 144° for forearm rotation arc. Further, the results showed an increase in the Mayo Elbow Performance Score from 82 to 88 points.
Radiographic signs of arthrosis were seen in 13 patients, based on the results. Researchers identified local infection around the incision, transient postoperative median nerve paralysis and postoperative posterior interosseous nerve palsy as postoperative complications associated with the procedure. Further surgery was required in four patients, according to the results. In addition, researchers found evidence of heterotopic ossification in five patients.
“The ideal surgical approach and treatment should be based on the mode and mechanism of injury, and intraoperative findings and modifying the standard surgical treatment approach for terrible triad elbow injuries may be beneficial,” the authors wrote. – by Casey Tingle
Reference:
Liu G, et al. Medicine. 2018;doi:10.1097/MD.0000000000010523.
For more information:
Zhijun Pan, PhD, can be reached at the department of orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Rd., Hangzhou 310009, P.R. China; email: zrpzj@zju.edu.cn.
Disclosure: Pan reports no relevant financial disclosures.