Evaluation of the effect of anterior median approach combined with lateral approach in the treatment of terrible triad of the elbow_West China Medical Journal

Authors：

LI Yuanli ,  WEI Peng , DENG Chunbiao , NIE Junlan , YANG Xin , JIANG Ping

Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 643000, P. R. China;

Corresponding?author：

WEI Peng, Email: weipeng789@vip.163.com

Keywords：

Anterior median approach of the elbow joint combined with the lateral approach; Medial and lateral approach of the elbow joint; Terrible triad of the elbow joint; Radial head fracture; Coronal process fracture

DOI：

10.7507/1002-0179.202008102

Video：

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Objective To explore the clinical significance of anterior median approach combined with lateral approach to the elbow joint in the treatment of terrible triad of the elbow.Methods We retrospectively collected the data of 63 cases who used the anterior median approach of the elbow joint combined with the lateral approach (group A, n=36) or the medial and lateral approach of the elbow (group B, n=27) in the treatment of terrible triad of the elbow between March 2014 and July 2019. The operation time, postoperative complications, and postoperative Mayo score of the elbow were compared between the two surgical approaches.Results The operation time of group A and group B was (93.78±7.78) and (106.93±10.35) min, respectively, and the difference was statistically significant (P<0.05). The patients in both groups completed operations successfully, without vascular or nerve injury. All the wounds healed by first intention. No redislocation or reoperation occurred. Ten months after operation, there was no significant difference in the excellence rate of Mayo score of the elbow (83.3% vs. 85.2%) or postoperative complication rate (16.7% vs. 14.8%) between the two groups (P>0.05).Conclusion The anterior median approach of the elbow joint combined with the lateral approach and the medial and lateral elbow approach for the treatment of terrible triad of the elbow are equivalent to the postoperative elbow function recovery. The operation time of the former is shorter than that of the latter, and the anterior approach reveals the coronal process intuitively and sufficiently. In the case that there is no medial ligament injury, the anterior median approach of the elbow joint combined with the lateral approach can be preferred.

Citation： LI Yuanli, WEI Peng, DENG Chunbiao, NIE Junlan, YANG Xin, JIANG Ping. Evaluation of the effect of anterior median approach combined with lateral approach in the treatment of terrible triad of the elbow. West China Medical Journal, 2020, 35(10): 1185-1188. doi: 10.7507/1002-0179.202008102 Copy

1.	Hotchkiss RN. Fractures and dislocations of the elbow// Rockwood CA Jr, Green DP, Bucholz RW, et al. Rockwood and Green’s fractures in adults: Volume I. 4th ed. Philadelphia, PA: Lippincott-Raven, 1996: 929-1024.
2.	Rodriguez-Martin J, Pretell-Mazzini J, Andres-Esteban EM, et al. Outcomes after terrible triads of the elbow treated with the current surgical protocols. A review. Int Orthop, 2011, 35(6): 851-860.
3.	Chan K, MacDermid JC, Faber KJ, et al. Can we treat select terrible triad injuries nonoperatively?. Clin Orthop Relat Res, 2014, 472(7): 2092-2099.
4.	Mathew PK, Athwal GS, Gj K. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009, 17(3): 137-151.
5.	Chen HW, Liu GD, Wu LJ. Complications of treating terrible triad injury of the elbow: a systematic review. PLoS One, 2014, 9(5): e97476.
6.	于連祥, 丁曉琳, 劉慶鵬, 等. 影響肘關節恐怖三聯征治療效果的因素分析. 中國矯形外科雜志, 2013, 21(12): 1190-1194.
7.	孟亞軻, 劉巖, 葉添文, 等. 肘關節“恐怖三聯征”的手術治療: 附 14 例報告. 中華肩肘外科電子雜志, 2015, 3(3): 151-155.
8.	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.
9.	Regan W, Morrey B. Fractures of the coronoid process of ulna. J Bone Joint Surg Am, 1989, 71(9): 1348-1354.
10.	查曄軍, 蔣協遠, 公茂琪, 等. 組配型橈骨頭假體置換治療橈骨頭粉碎性骨折. 中華創傷骨科雜志, 2012, 14(4): 288-294.
11.	Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am, 2002, 84-A(4): 547-551.
12.	Pugh DM, Wild LM, Schemitsch EH, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am, 2004, 86-A(6): 1122-1130.
13.	Schneeberger AG, Sadowski MM, Jacob HA. Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am, 2004, 86(5): 975-982.
14.	Pomianowski S, Morrey BF, Neale PG, et al. Contribution of monoblock and bipolar radial head prostheses to valgus stability of the elbow. J Bone Joint Surg Am, 2001, 83(12): 1829-1834.
15.	童鷺華, 汪根和, 葉華明. 外內側聯合入路手術治療肘關節恐怖三聯征. 贛南醫學院學報, 2018, 38(3): 250-252.
16.	周超. 手術治療肘關節恐怖三聯征. 臨床骨科雜志, 2016, 19(1): 110.

1. Hotchkiss RN. Fractures and dislocations of the elbow// Rockwood CA Jr, Green DP, Bucholz RW, et al. Rockwood and Green’s fractures in adults: Volume I. 4th ed. Philadelphia, PA: Lippincott-Raven, 1996: 929-1024.
2. Rodriguez-Martin J, Pretell-Mazzini J, Andres-Esteban EM, et al. Outcomes after terrible triads of the elbow treated with the current surgical protocols. A review. Int Orthop, 2011, 35(6): 851-860.
3. Chan K, MacDermid JC, Faber KJ, et al. Can we treat select terrible triad injuries nonoperatively?. Clin Orthop Relat Res, 2014, 472(7): 2092-2099.
4. Mathew PK, Athwal GS, Gj K. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009, 17(3): 137-151.
5. Chen HW, Liu GD, Wu LJ. Complications of treating terrible triad injury of the elbow: a systematic review. PLoS One, 2014, 9(5): e97476.
6. 于連祥, 丁曉琳, 劉慶鵬, 等. 影響肘關節恐怖三聯征治療效果的因素分析. 中國矯形外科雜志, 2013, 21(12): 1190-1194.
7. 孟亞軻, 劉巖, 葉添文, 等. 肘關節“恐怖三聯征”的手術治療: 附 14 例報告. 中華肩肘外科電子雜志, 2015, 3(3): 151-155.
8. 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.
9. Regan W, Morrey B. Fractures of the coronoid process of ulna. J Bone Joint Surg Am, 1989, 71(9): 1348-1354.
10. 查曄軍, 蔣協遠, 公茂琪, 等. 組配型橈骨頭假體置換治療橈骨頭粉碎性骨折. 中華創傷骨科雜志, 2012, 14(4): 288-294.
11. Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am, 2002, 84-A(4): 547-551.
12. Pugh DM, Wild LM, Schemitsch EH, et al. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am, 2004, 86-A(6): 1122-1130.
13. Schneeberger AG, Sadowski MM, Jacob HA. Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am, 2004, 86(5): 975-982.
14. Pomianowski S, Morrey BF, Neale PG, et al. Contribution of monoblock and bipolar radial head prostheses to valgus stability of the elbow. J Bone Joint Surg Am, 2001, 83(12): 1829-1834.
15. 童鷺華, 汪根和, 葉華明. 外內側聯合入路手術治療肘關節恐怖三聯征. 贛南醫學院學報, 2018, 38(3): 250-252.
16. 周超. 手術治療肘關節恐怖三聯征. 臨床骨科雜志, 2016, 19(1): 110.

West China Medical Journal

Evaluation of the effect of anterior median approach combined with lateral approach in the treatment of terrible triad of the elbow

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