Coronoid Fractures and the Terrible Triad

The purpose of this study was to investigate mid-term outcomes and complications after operative treatment according to a standardized protocol for terrible triad injuries. Twenty-four patients that were treated by a single surgeon with a standardized surgical protocol were retrospectively reviewed. After the complete reconstruction of radial head and/or lateral collateral ligament (LCL) complex through a lateral approach, coronoid process, and/or medial collateral ligament (MCL) complex through a medial approach were fixed if the elbow is unstable. For coronoid fractures, only type III were fixed in four cases (16.7%). Twenty-two LCL (91.7%) and five MCL (20.8%) complexes were repaired. At the final follow-up, the mean MEPS and Quick-DASH score were 91.5 and 17.3, respectively. There was no recurrent instability after operation in all cases. This study revealed that operative treatment that was based on our standardized protocol for terrible triad injuries yielded satisfactory mid-term clinical and radiographic outcomes without any recurrent instability. These results suggest that Type I and II coronoid fractures in terrible triad injuries do not need to be fixed if the radial head and ligamentous complex are completely reconstructed.

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Retrograde Screw Fixation Results of Coronoid Fractures in Terrible Triad

British Journal of Medicine and Medical Research ◽

10.9734/bjmmr/2015/18086 ◽

2015 ◽

Vol 8 (9) ◽

pp. 802-805 ◽

Cited By ~ 1

Author(s):

Çetin Isik ◽

Mesut Tahta ◽

M. Aksekili ◽

Ahmet Firat ◽

Osman Tecimel ◽

...

Keyword(s):

Screw Fixation ◽

Terrible Triad ◽

Coronoid Fractures

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Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach

Journal of International Medical Research ◽

10.1177/0300060518771263 ◽

2018 ◽

Vol 46 (8) ◽

pp. 3053-3064 ◽

Cited By ~ 1

Author(s):

Guanyi Liu ◽

Jingen Hu ◽

Weihu Ma ◽

Ming Li ◽

Rongming Xu ◽

...

Keyword(s):

Surgical Treatment ◽

Surgical Approach ◽

Lateral Collateral Ligament ◽

Surgical Approaches ◽

Terrible Triad ◽

Coronoid Fracture ◽

Flexion Extension ◽

Post Traumatic ◽

Coronoid Fractures ◽

The Mean

Summary Objective To report the results of the surgical treatment of terrible triad injury with anteromedial coronoid fracture through a combined surgical approach. Methods This retrospective study evaluated data from patients who underwent surgery to repair terrible triad injuries and anteromedial coronoid fractures. Surgical treatment involved radial head repair or replacement, medial and lateral collateral ligament repair, and coronoid fracture fixation through combined approaches. Evaluations were performed using the Mayo Elbow Performance Score (MEPS) and anteroposterior and lateral radiographs of the elbow. Results Twenty-two patients (15 males, seven females; mean ± SD age, 47.5 ± 11.4 years) were enrolled in this study. Fracture union and concentric reduction of both the ulnotrochlear and radiocapitellar articulations were achieved in all patients. The mean ± SD follow-up was 31.6 ± 11.9 months. The mean ± SD arc of flexion–extension was 110.3° ± 26.3° and arc of forearm rotation was 139.5° ± 17.1°. The mean ± SD MEPS was 88.1 ± 12.2 points, with results classified as excellent in eight elbows, good in ten, and fair in four. Six patients had radiographic signs of post-traumatic arthritis. Three patients required secondary surgeries. Conclusion Combined surgical approaches can be considered for the treatment of terrible triad injuries in association with anteromedial coronoid fractures.

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Osteology of the coronoid process with clinical correlation to coronoid fractures in terrible triad injuries

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2012.10.038 ◽

2013 ◽

Vol 22 (3) ◽

pp. 323-328 ◽

Cited By ~ 9

Author(s):

Lee M. Reichel ◽

Graham S. Milam ◽

Cody D. Hillin ◽

Charles A. Reitman

Keyword(s):

Coronoid Process ◽

Clinical Correlation ◽

Terrible Triad ◽

Coronoid Fractures

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Injuries to the Coronoid Process of the Ulna with Involvement of the Lesser Sigmoid Notch

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1263-1742 ◽

2020 ◽

Author(s):

Valentin Rausch ◽

Sina Neugebauer ◽

Tim Leschinger ◽

Lars Müller ◽

Kilian Wegmann ◽

...

Keyword(s):

Fragment Size ◽

Coronoid Process ◽

Annular Ligament ◽

Concomitant Injuries ◽

Proximal Ulna ◽

Sigmoid Notch ◽

Coronoid Fractures ◽

The Mean ◽

The Stability ◽

Arthritic Changes

Abstract Introduction This study aimed to describe the involvement of the lesser sigmoid notch in fractures to the coronoid process. We hypothesized that injuries to the lateral aspect of the coronoid process regularly involve the annular ligament insertion at the anterior lesser sigmoid notch. Material and Methods Patients treated for a coronoid process fracture at our institution between 06/2011 and 07/2018 were included. We excluded patients < 18 years, patients with arthritic changes or previous operative treatment to the elbow, and patients with concomitant injuries to the proximal ulna. In patients with involvement of the lesser sigmoid notch, the coronoid height and fragment size (anteroposterior, mediolateral, and craniocaudal) were measured. Results Seventy-two patients (mean age: 47 years ± 17.6) could be included in the study. Twenty-one patients (29.2%) had a fracture involving the lateral sigmoid notch. The mean anteroposterior fragment length was 7 ± 1.6 mm. The fragment affected a mean of 43 ± 10.8% of the coronoid height. The mean mediolateral size of the fragment was 10 ± 5.0 mm, and the mean cranio-caudal size was 7 ± 2.7 mm. Conclusion Coronoid fractures regularly include the lesser sigmoid notch. These injuries possibly affect the anterior annular ligament insertion which is important for the stability of the proximal radioulnar joint and varus stability of the elbow.

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