Right shoulder and arm, posterior view
Right shoulder and arm, posterior view
Medial aspect of right forearm
Left Brachial plexus
Posterior view of right elbow
Blood supply and anastomosis around the right elbow. Anterior view
The triangular structure of distal humerus at elbow joint provides structural strength.
Anterior view right distal humerus bone
The elbow joint is a hinge joint with axis of rotation around throchlear axis
Extensor muscles
Flexor muscles
Haversion bone system
The terrible triad elbow injury is a traumatic elbow injury characterized by elbow dislocation, radial head/neck fracture and a coronoid fracture.
Mechanism: fall on extended arm with an axial, valgus and posterolateral complex disruption producing a posterolateral elbow dislocation.
Posterolateral elbow dislocation with radial neck and coronoid fractures
Type Ⅰ: avulsion tip
Type Ⅱ: single or comminuted fracture involving < 50% of coronoid
Type Ⅲ: single or comminuted fracture involving > 50% of coronoid
Non-surgical management is seldom done with immobilization in a splint/cast for closed fractures provided:
Surgery considerations for radial head/neck injury associated with Terrible Triad. ORIF coronoid and lateral elbow ligament complex.
Coronoid fixation options include:
Hinged elbow external fixator
Jones et al treatment algorithm for surgical treatment of terrible triad elbow injuries (2017)
Coronoid fixation options include:
Approach: Through site of radial head/neck fracture or lateral approach. Medial approach additional option. A medial over-the-top, Taylor and Scham or FCU split approach may be used.
Fracture reduction and screw fixation for large fracture fragments. Type fractures may require a Lasso technique by suture fixation of Brachialis muscle/tendon complex and securing it by tie fixation after passing it to through olecranon bone tunnels.
Hinged external fixator can supplement unstable elbow fracture ORIF and ligament repair.
Arc for safe zone for application of external fixator pins of right arm
Arm sling
Hand grip exercises with arm in splint
Strength exercises only performed after union