Current Concepts in Management of the Terrible Triad Elbow Injury


Posterior dislocation of the elbow with associated fractures of the coronoid process and radial head has been termed the"terrible triad"because of the many challenges encountered in its management. There has been little discussion of these injuries in the literature, particularly with regard to patterns of injury, decisions regarding treatment, surgical tactics, and outcomes. However, with recent advances in our understanding of elbow biomechanics, improved imaging, and better implant and prosthesis designs, a systematic approach to treatment of the terrible triad injury can now be employed. This includes fixation or replacement of the radial head, fixation of the coronoid fragment, repair of the lateral collateral ligament complex, and repair of the medial collateral ligament and/or application of a hinged external fixator for patients with residual instability.

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