HINGED EXTERNAL FIXATOR WITH MINI-PLATE TO TREAT TERRIBLE TRIAD OF ELBOW_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Yong , WANG Fuchuan.

Hand Surgery of Trauma Orthopedics, Xingtai People’s Hospital, Affiliated Hospital of Hebei Medical University, Xingtai Hebei, 054031, P.R.China. Corresponding author: WANG Fuchuan, E-mail: wfc32862161@126.com;

Corresponding author：

Keywords：

Terrible triad of the elbow; Hinged external fixator; Mini-plate Internal fixation

DOI：

10.7507/1002-1892.20130034

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Objective To investigate the effectiveness of hinged external fixator with mini-plate to treat terrible triad of the elbow. Methods Between August 2008 and June 2011, 11 patients with terrible triad of the elbow were treated with hinged external fixator combined with mini-plate. There were 9 males and 2 females, aged 22-56 years (mean, 34 years). The injuries were caused by falling from height in 8 cases and traffic accident in 3 cases. All patients were closed injury. The time from injury to operation varied from 8 hours to 7 days (mean, 3.7 days). According to Mason classification standard, all radial head fractures were type IV and complicated by posterior dislocation of the elbow; according to Regan-Morrey classification standard, ulna coronary process fractures were type I in 3 cases, type II in 3 cases, and type III in 5 cases. Results All the patients achieved primary healing of incision after operation and no nerve injury occurred. The patients were followed up 12-20 months (mean, 15 months). Two cases had screw channel infection after 12 weeks of operation, and 1 case had mild heterotopic ossification of the elbow after 4 months of operation. X-ray films showed that all fractures healed from 8 to 20 weeks (mean, 16 weeks). No recurrent dislocation or instability of the elbow occurred. At 12 months after operation, the elbow range of motion (ROM) were 120-145° (mean, 135°) in flexion, 0-25° (mean, 10°) in extension, 50-90° (mean, 70°) in pronation, and 50-80° (mean, 60°) in supination. According to Mayo elbow function evaluation standard, the results were excellent in 5 cases, good in 4 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. Conclusion Hinged external fixator with mini-plate can enhance postoperative stability of the elbow. This therapy is beneficial to early functional exercise and obviously decrease the disability rate caused by complex damage on the elbow.

Citation： YANG Yong,WANG Fuchuan.. HINGED EXTERNAL FIXATOR WITH MINI-PLATE TO TREAT TERRIBLE TRIAD OF ELBOW. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(2): 151-154. doi: 10.7507/1002-1892.20130034 Copy

1.	Armstrong AD. The terrible triad injury of the elbow. Curr Opin Orthop, 2005, 3: 267-270.
2.	Hotchkiss RN. Displaced fractures of the radial head: internal fixation of excision? J Am Acad Orthop Surg, 1997, 5(1): 1-10.
3.	Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg (Am), 1989, 71(9): 1348-1354.
4.	陈硕, 黄富国, 钟刚, 等. 尺骨冠突骨折合并内侧副韧带前束损伤致肘关节后外侧旋转不稳定的生物力学研究. 中国修复重建外科杂志, 2010, 24(2): 215-218.
5.	Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg (Am), 2002, 84-A(4): 547-551.
6.	Heim U. Kombinierte verlezungen von radius and ulna im proximalen unterarmsegment. Hefte Unfallchir, 1994, 241: 61-79.
7.	Weber MF, Barbosa DM, Belentani C, et al. Coronoid process of the ulna: paleopathologic and anatomic study with imaging correlation. Emphasis on the anteromedial “facet”. Skeletal Radiol, 2009, 38(1): 61-67.
8.	Mathew PK, Athwal GS, King GJ. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009, 17(3): 137-151.
9.	Lee DH. Treatment options for complex elbow fracture dislocations. Injury, 2001, 32 Suppl 4: SD41-69.
10.	顾龙殿, 顾利华, 许大峰, 等. 微型钢板螺钉内固定治疗桡骨头骨折. 中国骨与关节损伤杂志, 2011, 26(3): 253-254.
11.	匡新建, 蔡航, 鲍丰, 等. 微型钢板治疗尺骨冠状突骨折. 中国修复重建外科杂志, 2010, 24(9): 1097-1099.
12.	张俊峰, 黄新民, 王雁先, 等. 单臂铰链式外固定架辅助固定治疗复杂肘关节骨折脱位20例分析. 中国误诊学杂志, 2012, 12(8): 1935-1936.
13.	万里, 王国新. 矫形器在骨折后肘关节功能障碍康复中的应用. 中国临床康复, 2003, 7(20): 2872.
14.	Morrey BF, Hotchkiss RN. External fixator of the elbow//Morrey BF. The elbow and its disorders. Philadelphia: Sanders, 2000: 457-467.
15.	Pennig D, Gausepohl T, Mader K. Transarticular fixation with the capacity for motion in fracture dislocations of the elbow. Injury, 2000, 31 Suppl 1: 35-44.
16.	马灿泽. 超关节外固定架有限内固定治疗肱骨远端粉碎性骨折疗效观察. 湖南中医药大学学报, 2012, 32(4): 51-52.

1. Armstrong AD. The terrible triad injury of the elbow. Curr Opin Orthop, 2005, 3: 267-270.
2. Hotchkiss RN. Displaced fractures of the radial head: internal fixation of excision? J Am Acad Orthop Surg, 1997, 5(1): 1-10.
3. Regan W, Morrey B. Fractures of the coronoid process of the ulna. J Bone Joint Surg (Am), 1989, 71(9): 1348-1354.
4. 陈硕, 黄富国, 钟刚, 等. 尺骨冠突骨折合并内侧副韧带前束损伤致肘关节后外侧旋转不稳定的生物力学研究. 中国修复重建外科杂志, 2010, 24(2): 215-218.
5. Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg (Am), 2002, 84-A(4): 547-551.
6. Heim U. Kombinierte verlezungen von radius and ulna im proximalen unterarmsegment. Hefte Unfallchir, 1994, 241: 61-79.
7. Weber MF, Barbosa DM, Belentani C, et al. Coronoid process of the ulna: paleopathologic and anatomic study with imaging correlation. Emphasis on the anteromedial “facet”. Skeletal Radiol, 2009, 38(1): 61-67.
8. Mathew PK, Athwal GS, King GJ. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg, 2009, 17(3): 137-151.
9. Lee DH. Treatment options for complex elbow fracture dislocations. Injury, 2001, 32 Suppl 4: SD41-69.
10. 顾龙殿, 顾利华, 许大峰, 等. 微型钢板螺钉内固定治疗桡骨头骨折. 中国骨与关节损伤杂志, 2011, 26(3): 253-254.
11. 匡新建, 蔡航, 鲍丰, 等. 微型钢板治疗尺骨冠状突骨折. 中国修复重建外科杂志, 2010, 24(9): 1097-1099.
12. 张俊峰, 黄新民, 王雁先, 等. 单臂铰链式外固定架辅助固定治疗复杂肘关节骨折脱位20例分析. 中国误诊学杂志, 2012, 12(8): 1935-1936.
13. 万里, 王国新. 矫形器在骨折后肘关节功能障碍康复中的应用. 中国临床康复, 2003, 7(20): 2872.
14. Morrey BF, Hotchkiss RN. External fixator of the elbow//Morrey BF. The elbow and its disorders. Philadelphia: Sanders, 2000: 457-467.
15. Pennig D, Gausepohl T, Mader K. Transarticular fixation with the capacity for motion in fracture dislocations of the elbow. Injury, 2000, 31 Suppl 1: 35-44.
16. 马灿泽. 超关节外固定架有限内固定治疗肱骨远端粉碎性骨折疗效观察. 湖南中医药大学学报, 2012, 32(4): 51-52.

Chinese Journal of Reparative and Reconstructive Surgery

HINGED EXTERNAL FIXATOR WITH MINI-PLATE TO TREAT TERRIBLE TRIAD OF ELBOW

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