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

2018 ◽  
Vol 46 (8) ◽  
pp. 3053-3064 ◽  
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.

scholarly journals Use of Suture Anchors for Coronoid Fractures in the Terrible Triad of the Elbow

2009 ◽  
Vol 17 (1) ◽  
pp. 31-35 ◽  
Author(s):  
V Pai ◽  
V Pai
Keyword(s):  
Radial Head ◽  
Lateral Collateral Ligament ◽  
Lateral Condyle ◽  
Type I ◽  
Suture Anchors ◽  
Terrible Triad ◽  
Collateral Ligament ◽  
Range Of Movement ◽  
Flexion Extension ◽  
The Mean

Purpose. To report outcomes in 6 patients with the terrible triad of the elbow treated with our modified protocol. Methods. 6 men aged 26 to 54 years underwent surgery for the terrible triad of the elbow by a single surgeon. All the patients had a displaced comminuted fracture of the radius, posterior dislocation of the elbow, and Morrey type-I fracture of the coronoid. They all underwent replacement of the radial head and repair of the lateral collateral ligament to the isometric part of the lateral condyle using suture anchors. Five had an additional capsular fixation to the anterior coronoid using suture anchors; in patient 6 the coronoid was not repaired because it was stable. Functional outcomes were evaluated using the Hospital for Special Surgery (HSS) elbow assessment score. Bone union, implant loosening, heterotopic ossification, and degenerative changes were assessed using anteroposterior and lateral radiographs. Results. After a mean follow-up of 2.2 (range, 1–3) years, the mean arc of flexion-extension was 116 degrees and the mean flexion contracture was 15 degrees. All patients maintained a concentric reduction of both the ulnotrochlear and the radiocapitellar articulation, with isometric fixation of the lateral collateral ligament. No patient had dislocation of the radial-head prosthesis. All had good-to-excellent HSS elbow scores, and none required re-operation. Patient 2 had neuropraxia of the radial nerve, which recovered within 3 months. Patient 4 had a range of movement of only 20 to 100 degrees, but was satisfied with the outcome. Conclusion. Repair of the articular capsule using suture anchors in addition to replacement of the radial head and repair of the lateral collateral ligament achieves favourable outcome in patients with the terible triad of the elbow.

scholarly journals Does the Coronoid Always Need to Be Fixed in Terrible Triad Injuries of the Elbow? Mid-Term Postoperative Outcomes Following a Standardized Protocol

2020 ◽  
Vol 9 (11) ◽  
pp. 3500
Author(s):  
Beom-Soo Kim ◽  
Du-Han Kim ◽  
Seok-Ho Byun ◽  
Chul-Hyun Cho
Keyword(s):  
Operative Treatment ◽  
Radial Head ◽  
Lateral Collateral Ligament ◽  
Type I ◽  
Dash Score ◽  
Terrible Triad ◽  
Collateral Ligament ◽  
Recurrent Instability ◽  
Standardized Protocol ◽  
Coronoid Fractures

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.

The role of the posterior bundle of the medial collateral ligament in posteromedial rotatory instability of the elbow

2018 ◽  
Vol 100-B (8) ◽  
pp. 1060-1065 ◽  
Author(s):  
J-T. Hwang ◽  
M. N. Shields ◽  
L. J. Berglund ◽  
A. W. Hooke ◽  
J. S. Fitzsimmons ◽  
...  
Keyword(s):  
Contact Pressure ◽  
Medial Collateral Ligament ◽  
Lateral Collateral Ligament ◽  
Collateral Ligament ◽  
Coronoid Fracture ◽  
Rotatory Instability ◽  
Intact Group ◽  
Joint Contact ◽  
The Mean ◽  
Contact Pressures

Aims The aim of this study was to evaluate two hypotheses. First, that disruption of posterior bundle of the medial collateral ligament (PMCL) has to occur for the elbow to subluxate in cases of posteromedial rotatory instability (PMRI) and second, that ulnohumeral contact pressures increase after disruption of the PMCL. Materials and Methods Six human cadaveric elbows were prepared on a custom-designed apparatus which allowed muscle loading and passive elbow motion under gravitational varus. Joint contact pressures were measured sequentially in the intact elbow (INTACT), followed by an anteromedial subtype two coronoid fracture (COR), a lateral collateral ligament (LCL) tear (COR + LCL), and a PMCL tear (COR + LCL + PMCL). Results There was no subluxation or joint incongruity in the INTACT, COR, and COR + LCL specimens. All specimens in the COR + LCL + PMCL group subluxated under gravity-varus loads. The mean articular contact pressure of the COR + LCL group was significantly higher than those in the INTACT and the COR groups. The mean articular contact pressure of the COR + LCL + PMCL group was significantly higher than that of the INTACT group, but not higher than that of the COR + LCL group. Conclusion In the presence of an anteromedial fracture and disruption of the LCL, the posterior bundle of the MCL has to be disrupted for gross subluxation of the elbow to occur. However, elevated joint contact pressures are seen after an anteromedial fracture and LCL disruption even in the absence of such subluxation. Cite this article: Bone Joint J 2018;100-B:1060–5.

Surgical Treatment of Pancreatic Insulinomas: A Series of 15 Years

2021 ◽  
Vol 3 (3) ◽  
pp. 1-4
Author(s):  
Vanessa Rebelo dos Santos ◽  
◽  
Carlota Ramos ◽  
Rafael Cruz ◽  
◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Local Recurrence ◽  
Surgical Approach ◽  
Medical Records ◽  
Surgical Intervention ◽  
Female Gender ◽  
The Body ◽  
Head Of The Pancreas ◽  
The Mean

Insulinomas, although rare, are the most common pancreatic functioning neuroendocrine tumors. The diagnostic workup is commonly made late in time and surgical treatment is the only curative method. Our aim was to analyze the surgical approach to pancreatic insulinomas, through a 15-year series of patients who underwent surgery for this matter. From January 2006 to December 2020, we performed a retrospective review of the medical records of all the patients who underwent surgical treatment for insulinoma. Fourteen patients with insulinoma performed surgical intervention, 78,6% were of the female gender and the mean age was 48 years (19-86 years). Four (28,6%) of the tumors were located in the head of the pancreas, 5 (35,7%) in the body and 5 (35,7%) in the tail. Complications occurred in 4 patients (28,6%) following surgery. On follow-up, there was one (7,1%) case of local recurrence, thus necessitating a new surgical intervention [1-8].

scholarly journals The Surgical Treatment of Posttraumatic Skull Base Defects with Cerebrospinal Fluid Leak

2017 ◽  
Vol 79 (02) ◽  
pp. 205-216 ◽  
Author(s):  
Ashish Thapa ◽  
Bing-Xi Lei ◽  
Mei-Guang Zheng ◽  
Zhong-Jun Li ◽  
Zheng-Hao Liu ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Skull Base ◽  
Surgical Approach ◽  
Common Factors ◽  
Csf Leak ◽  
Surgical Approaches ◽  
Skull Base Defect ◽  
The Common ◽  
Skull Base Defects

Objectives The objective was to explore further the surgical treatment of posttraumatic skull base defects with cerebrospinal fluid (CSF) leak and to identify the most common factors affecting the surgical treatment of posttraumatic skull base defect with CSF leak retrospectively. Materials and Methods This study included 144 patients with head trauma having skull base defect with CSF leak who had been surgically treated at Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from 1998 to June 2016. There were 113 (78.5%) males and 31 (21.5%) females, with age ranging from 1 to 78 years and mean age of 26.58 ± 14.95 years. We explored the surgical approaches for the treatment of the skull base defect and the graft materials used and also measured the association among surgical approaches; location, size, and type of skull base defects; presence or absence of associated intracranial pathologies; postoperative complications; outcome; age; Glasgow outcome score (GOS) at discharge; and days of hospital stay. Results The location, size, and types of skull base defect and the presence of associated intracranial pathologies were the common factors identified not only for choosing the appropriate surgical approach but also for choosing the materials for defect repair, timing of the surgery, and the method used for the defect as well as leak repair. The statistically significant correlation with p < 0.001 was found in this study. Conclusion From this study, we could conclude that size, location, and types of the defect and the presence of associated intracranial injuries were the common factors that affected the surgical treatment of posttraumatic skull base defect with CSF leak. Hence, the importance of careful evaluation of these factors is essential for proper selection of the surgical approach and for avoiding unnecessary hassles.

Development of 3D Finite Element Model of Human Elbow to Study Elbow Dislocation and Instability

2009 ◽  
Author(s):  
Samer Khodor Al Kork ◽  
Farid Amirouche ◽  
Edward Abraham ◽  
Mark Gonzalez
Keyword(s):  
Finite Element ◽  
Medial Collateral Ligament ◽  
Inverse Dynamics ◽  
Elbow Dislocation ◽  
Lateral Collateral Ligament ◽  
Element Model ◽  
Fe Model ◽  
Collateral Ligament ◽  
Coronoid Fracture ◽  
Flexion Extension

The mechanics of elbow dislocation and its stages of dislocation are complex and not well understood. Reconstructing a fall where someone lands on their hand is one of the most challenging problem in biomechanics. Current models which attempt to reconstruct falls usually focus on experimental kinematical conditions that cause the fall coupled with inverse dynamics to determine the joint and muscles forces [1,2] to provide on insight into the joint instability. Our hypothesis based on our experimental investigation is that the mechanism of posterior elbow dislocation is initiated at radial head where the ulna and coronoid fracture followed by anterior tearing of the joint capsule, lateral collateral ligament will then rupture followed by posterior medial collateral ligament rupture and then the medial collateral ligament peeling off the ulna. In this study we developed a quasi-static three-dimensional finite element of human elbow joint, and conducted several cadaveric studies to study elbow dislocation. The FE model is used to investigate how the ligaments, cartilages behave under different flexion, extension of the elbow. Dislocation is investigated as function of different loads and moments applied to the radius-ulna with arm being flexed and configured into a supination or pronation.

scholarly journals The 6 thalamic regions: surgical approaches to thalamic cavernous malformations, operative results, and clinical outcomes

2015 ◽  
Vol 123 (3) ◽  
pp. 676-685 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Robert F. Spetzler
Keyword(s):  
Surgical Approach ◽  
Surgical Approaches ◽  
Cavernous Malformations ◽  
Second Stage ◽  
Common Location ◽  
Orbitozygomatic Approach ◽  
The Mean ◽  
Selection Of ◽  
The Ideal

OBJECT The ideal surgical approach to thalamic cavernous malformations (CMs) varies according to their location within the thalamus. To standardize surgical approaches, the authors have divided the thalamus into 6 different regions and matched them with the corresponding surgical approach. METHODS The regions were defined as Region 1 (anteroinferior), Region 2 (medial), Region 3 (lateral), Region 4 (posterosuperior), Region 5 (lateral posteroinferior), and Region 6 (medial posteroinferior). The senior author’s surgical experience with 46 thalamic CMs was reviewed according to this classification. An orbitozygomatic approach was used for Region 1; anterior ipsilateral transcallosal for Region 2; anterior contralateral transcallosal for Region 3; posterior transcallosal for Region 4; parietooccipital transventricularfor Region 5; and supracerebellar-infratentorial for Region 6. RESULTS Region 3 was the most common location (17 [37%]). There were 5 CMs in Region 1 (11%), 9 in Region 2 (20%), 17 in Region 3 (37%), 3 in Region 4 (6%), 4 in Region 5 (9%), and 8 in Region 6 (17%). Complete resection was achieved in all patients except for 2, who required a second-stage operation. The mean follow-up period was 1.7 years (range 6 months-9 years). At the last clinical follow-up, 40 patients (87%) had an excellent or good outcome (modified Rankin Scale [mRS] scores 0–2) and 6 (13%) had poor outcome (mRS scores 3–4). Relative to their preoperative condition, 42 patients (91%) were unchanged or improved, and 4 (9%) were worse. CONCLUSIONS The authors have presented the largest series reported to date of surgically treated thalamic CMs, achieving excellent results using this methodology. In the authors’ experience, conceptually dividing the thalamus into 6 different regions aids in the selection of the ideal surgical approach fora specific region.

scholarly journals TERRIBLE TRIAD OF THE ELBOW: FUNCTIONAL RESULTS OF SURGICAL TREATMENT

2017 ◽  
Vol 25 (6) ◽  
pp. 283-286
Author(s):  
ROBERTO YUKIO IKEMOTO ◽  
JOEL MURACHOVSKY ◽  
ROGÉRIO SERPONE BUENO ◽  
LUIS GUSTAVO PRATA NASCIMENTO ◽  
ADRIANO BORDINI CARMARGO ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Functional Results ◽  
Terrible Triad ◽  
Level Of Evidence ◽  
Mayo Elbow Performance Score ◽  
Results Of Treatment ◽  
Type Iv ◽  
Flexion Extension ◽  
Elbow Injuries

ABSTRACT Objective: To evaluate the functional and radiographic results of patients who underwent surgical treatment for terrible triad-type elbow injuries (TTE). Methods: We retrospectively evaluated 20 patients, including one case with bilateral injuries (total of 21 elbows) that were surgically treated from January 2004 to July 2014. We evaluated the functional results of treatment by measuring the restored range of motion (ROM) of the elbow, using the DASH (Disabilities of the Arm, Shoulder and Hand) and MEPS (Mayo Elbow Performance Score) scores. Complications and the development of osteoarthritis and heterotopic ossification (HO) were also evaluated. Results: Eight elbows (38%) required additional surgical treatment; HO was observed in eight elbows (38%) and severe osteoarthritis (Broberg-Morrey type IV) was seen in only one case (4%). Nevertheless, we obtained good functional results, 14.27 on the DASH and 84 on the MEPS. The average ROM for flexion-extension was 101° (20-140°) and for pronation-supination was 112.85° (0-180°). Conclusion: When TTE injuries are treated systematically, even despite variations in these injuries, functional ROM and scores ranging from good to excellent can be obtained. Level of Evidence IV, Case Series.

scholarly journals Surgical treatment for Pipkin type IV femoral head fracture

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668497 ◽  
Author(s):  
Yi-Hsun Yu ◽  
Yung-Heng Hsu ◽  
Ying-Chao Chou ◽  
I-Chuan Tseng ◽  
Chun-Yi Su ◽  
...  
Keyword(s):  
Femoral Head ◽  
Functional Results ◽  
Surgical Approaches ◽  
Consecutive Series ◽  
Radiological Outcome ◽  
Femoral Head Fracture ◽  
Type Iv ◽  
Post Traumatic ◽  
The Mean

Purpose: Pipkin type IV femoral head (FH) fracture was thought as poor prognosis. There were several surgical approaches and treatments for this difficult fracture. However, there was no one treatment superior to another. We reviewed a serious of patients with Pipkin type IV FH fracture underwent surgery via a modified Gibson approach. Methods: We reviewed a consecutive series of nine patients with Pipkin type IV FH fracture under surgery via a modified Gibson approach between 2012 and 2013. The surgical procedure was completely described, and the radiological outcome and the functional outcome were also reviewed. Results: The mean follow-up duration was 17 (12–30) months. The mean Merle d’Aubigne score was 16 (8–19). Seven patients had anatomical reductions, and two had imperfect reductions by Matta’s grading. There was no early posttraumatic osteoarthritis during the follow-up period. One patient with early post-traumatic osteonecrosis 3 months after index surgery underwent total hip arthroplasty. Conclusions: Through this surgery approach to fix the FH and the acetabulum, the radiological and the functional results were satisfactory. We still need more patients with prospective study to find an optimal surgical approach for Pipkin type IV FH fracture.

scholarly journals Outcomes following surgical management of complex terrible triad injuries of the elbow: a single surgeon case series

2017 ◽  
Vol 10 (3) ◽  
pp. 216-222 ◽  
Author(s):  
Peter Domos ◽  
Emmet Griffiths ◽  
Andrew White
Keyword(s):  
Surgical Management ◽  
Case Series ◽  
Lateral Ligament ◽  
Joint Stability ◽  
Terrible Triad ◽  
Subsequent Removal ◽  
Ligament Repair ◽  
Flexion Extension ◽  
The Mean

Background Terrible triad injuries of the elbow are complex injuries to treat and we report our outcomes following surgical management. Methods Twenty-two consecutive patients who underwent fixation of terrible triad injuries between 2007 and 2012 were identified. Clinical outcomes were assessed by examination, visual analogue scores (VAS), Oxford Elbow Score (OES), Mayo Elbow Performance Index (MEPI) and QuickDash score (QD). Results The mean age of patients was 47 years, with a mean follow-up of 32 months. All patients underwent lateral ligament repair, with additional medial ligament repair in four cases. Thirteen patients required repair of the coronoid and 18 patients required surgery to the radial head. The mean flexion–extension arc was 113°, with mean prono-supination of 136°. The functional elbow scores revealed good outcomes in the majority (mean OES of 37, MEPI of 79 and QD of 21). The overall complication rate was 41%. In total, 23% required reoperation, with one patient requiring fasciotomy for acute compartment syndrome and four requiring subsequent removal of metalwork as a result of stiffness. Conclusions Recognition of this complex injury pattern and appropriate restoration of the joint stability are the prerequisites. Systematic surgical approach is effective and can provide both stability and good function, in most cases.

Sign in / Sign up

Export Citation Format

Share Document