Abstract

Objectives: Complex elbow fractures have a predisposition for undesirable outcomes even with surgical management. The aim of this study was to evaluate the functional outcome of patients with traumatic unstable elbow Injuries that were managed surgically, as well as how to select the proper surgical approach and fixation guided by pre-operative planning. Analyzing their functional outcomes would help formulate future evidence-based guidelines on elbow terrible triad injury management in clinical practice.

Methods: All the surgical cases for Traumatic Unstable Elbow Injuries were collected from a single tertiary hospital in the country that deals exclusively with these types of injuries. The database included 19 patients that were treated between 2013 until 2018. All the patient agreed to participate in this study. They were asked to fill in the Mayo Elbow Performance Score (MEPS) at baseline first clinic after hospital discharge, and later at final follow up after completion of physiotherapy. Both functional outcomes and complications were correlated with clinical and radiological evaluation.

Results: A total of 19 cases of terrible triad of the elbowwereincluded in the studyanalysis. The study sample included 19 participants (31.6% females and 68.4% males). Results showed that MEPS and ROM significantly improved after the completion of follow up compared to the baseline. The median extension score decreased from 20 to 10 (P < 0.05). The median flexion score increased from 122 to 140 (p = 0.001 using Wilcoxon signed-rank test). The median supination score increased from 45 to 80 (p< 0.05) while the median pronation score increased from 42.5 to 70 (p = 0.05). The median MEPS scores significantly increased from 60 to 85 (p< 0.001). When analyzed as a categorical variable, results showed that the percentage of patients with good MEPS score increased from 21.1% to 68.4% (p< 0.001 using McNemar’s test).

In terms of complications, 6 of the 19 patients needed a second surgical intervention with joint stiffness as the leading cause

Conclusion: Terrible triad injuries of the elbow are a result of high energy trauma. These types of injuries lead to unstable elbows that requires surgical intervention, extensive post-operative physiotherapy and a high possibility of reoperation is required. We conclude that good outcomes after this injury can be achieved by adequate preoperative planning, stable fixation, aggressive rehabilitation, regular outpatient follows-up and complication anticipation and management.

Keywords: Terrible triad;Elbow;Surgery;Joint;Complex fracture