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Radial head replacement or repair for the terrible triad of the elbow: which procedure is better?
Author(s) -
Yan Mingming,
Ni Jiangdong,
Song Deye,
Ding Muliang,
Liu Tang,
Huang Jun
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13060
Subject(s) - medicine , elbow , subluxation , triad (sociology) , surgery , radial head , radial head fracture , psychology , alternative medicine , pathology , psychoanalysis
Background The terrible triad of the elbow comprises an ulnar coronoid process fracture, a radial head ( RH ) fracture and posterior dislocation of the elbow. It is considered severe by many clinicians because it is difficult to repair and has a poor prognosis; therefore, it deserves more attention. Methods Thirty‐nine patients with terrible triad of the elbow characterized by a M ason type‐ III RH fracture were randomly divided into either an RH repair group ( n = 19) or an RH replacement group ( n = 20). The complication rates, radiological outcomes, M ayo E lbow P erformance S core and range of motion of the elbow were analysed. Results Follow‐up demonstrated no subluxation or recurrent dislocation of the elbow. Differences in surgery duration between the groups were significant ( P < 0.001). The outcomes in terms of M ayo E lbow P erformance S core ( P = 0.009), flexion–extension arc ( P = 0.01) and pronation–supination arc ( P = 0.04) were significantly better in the RH replacement group. In addition, patients in the RH replacement group displayed significantly fewer post‐surgery complications than those in the RH repair group ( P = 0.04). Conclusion Treating M ason type‐ III RH fracture in a terrible triad of the elbow with a metal RH prosthesis resulted in better clinical outcomes and fewer post‐surgery complications than treating a terrible triad of the elbow by repairing it with screws or plates. RH replacement might be a more effective approach to better managing a terrible triad of the elbow.