Long-Term Follow-up of Salvage Surgery Following Failed Primary Surgery for Terrible Triad Injury of the Elbow: A Case Report

Saito T, Matsumura T and Takeshita K

Department of Orthopedic Surgery, Jichi Medical University, Japan

^*Correspondance to: Tomohiro Saito 

 PDF  Full Text DOI: 10.25107/2474-1647.2483

Abstract

We present an 8-year follow-up experience and outcomes of Terrible Triad Injury of the elbow (TTI) salvage surgery after failed primary surgery. A 61-year-old man injured his right elbow during a fall. Initial radiographs showed elbow joint dislocation with comminuted radial head fracture and coronoid process fracture. The diagnosis was TTI. Primary surgery included repair of Lateral Ulnar Collateral Ligament (LUCL) disruption on the humeral side with a suture anchor, fixation of a comminuted coronoid fracture with K-wire, and 3 weeks of casting. The elbow remained dislocated, however, and stress examination indicated Posterolateral Rotational Instability (PLRI). He was referred to our hospital, where salvage surgery was performed 11 weeks after the injury. As the dislocation could not be reduced even under general anesthesia, we excised the osteophyte and released the anterior and posterior capsule and intra-articular adhesions. We then reconstructed the coronoid process by obliquely excising the radial head followed by radial head arthroplasty. As PLRI remained, the LUCL was reconstructed using double-stranded palmaris longus, after which the PLRI disappeared. The final surgical step was application of a hinged external fixator for 6 weeks. At 8 years after surgery, the patient has no elbow pain. His elbow extension/flexion range of motion is from 20° to 120°, and for supination/pronation it is 60°/45°. Stress examination revealed a stable elbow joint without pain. The Mayo Elbow Performance Score was 100. Preoperative planning is important for a successful outcome.

Keywords

Cite the article

Saito T, Matsumura T, Takeshita K. Long-Term Follow-up of Salvage Surgery Following Failed Primary Surgery for Terrible Triad Injury of the Elbow: A Case Report. Clin Surg. 2019; 4: 2483..