We describe a rare case of B/L terrible triad of elbow with associated proximal 1/3rd ulna fracture. The “terrible triad of the elbow” is a notorious combination of elbow dislocation and fractures of the coronoid process and radial head that has historically been difficult to manage and had an unsatisfactory prognosis 36-38, almost unavoidably causing long‐standing postoperative pain, elbow instability and a range of complications. Improved experience, techniques, and implants have advanced to the point where restoration of elbow stability can be expected. This injury almost always renders the elbow unstable requiring surgical intervention. Int Orthop. Our standard protocol • Rd iReduction of the di l idislocation • ORIF oror ReplacementReplacement ofof radialradial headhead • Repair anterior capsule to coronoid • Repair lateral structures • Brace for 4 weeks • Early ROM at ten days in the brace. A review. -Continue active elbow extension/!exion, as well as active and passive wrist !exion/extension and pro/ supination. In order for it to recover to its best function consistent rehabilitation is essential in order to obtain the optimal outcome after injury. Click here to download patient education documents offered by Dr Chad Myeroff in Saint Paul, Minneapolis and Woodbury in MN. The “terrible triad injury” of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture. The terrible triad of the elbow is a difficult injury with historically poor outcomes. REVIEW Outcomes after terrible triads of the elbow treated with the current surgical protocols. 11/21/2016 2 Biomechanics of Elbow Dislocation May involve bone or soft tissue Radial … resent our formulated protocol and treatment algorithm for el-bow fracture-dislocation in this series of thirty-two patients. 2017 Elbow lat lig recon terrible triad injury . An elbow dislocation associated with a radial head and coronoid fractures is termed a terrible triad. Edema Control: Per therapist. Most patients find their recovery time to be anywhere between 6-9 months depending on how quickly they heal and the extent […] References: Hotchkiss RN. Elbow fractures and dislocations cause injury to important stabilizing structures and require specific treatment in order to regain functionality of the elbow joint. In the current case, the NPWTi-d protocol allowed the authors to achieve a good result, despite the large degloving injury and the severe elbow fracture-dislocation. CONTRAINDICATIONS: Inoperable due to comorbidities. 6 men aged 26 to 54 years underwent surgery for the terrible triad of the elbow by a single surgeon. Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad. elbow dislocation with associated fracture; may take form of . Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad. of the elbow [3] Terrible triad injuries can lead to pain, recurrent instability, sti ness, and posttraumatic arthritis if not properly treated [6]. Our results indicate proper diagnoisis , planning with good fixation and rehabilitation protocol gives excellent clinical and radiological outcomes. PubMed PMID: 20449590; PubMed Central PMCID: PMC3103950. . Elbow Dislocation Rehabilitation Protocol Elbow Dislocation The Elbow Joint is the most complex joint in the body. Conclusions. The goal of treatment for these injuries is to restore the bony and ligamentous structures and provide su cient stability for early range of motion (ROM) [5]. INDICATIONS: Osteoligamentous terrible triad injury pattern with or without subluxation position following reduction and temporary immobilization. Download Dr. Myeroff's Protected Elbow ROM Diagram Information Sheet; Download Dr. Myeroff's Finger ROM Diagram Information Sheet; Download Dr. Myeroff's Ligament Protection Therapy Protocol Information Sheet; Download Dr Myeroff's Post-Op Protocol for Terrible Triad Fracture Dislocation – ORIF concepts. Methods. OPERATIVE TECHNIQUE: Lateral … Surgical technique - Treatment strategy of terrible triad of the elbow: Experience in Shanghai 6th People's Hospital. General Trauma Rehabilitation. The analyzed aspects of 20 patients, who underwent surgical treatment of the terrible triad of the elbow, were given as follows: Dash score (Disabilities of the Arm, Shoulder and Hand), Meps (Mayo Elbow Performance Score), pain according to VAS (visual analog scale), ROM (range of motion), patient satisfaction, degree of energy of the trauma, complications and radiographs. Methods. - Terrible triad injury of the elbow: how to improve outcomes? All the patients had a displaced comminuted fracture of the radius, posterior dislocation of the elbow, and Morrey type-I fracture of the coronoid. In terrible triad injuries of the elbow, most coronoid process fractures are type I fractures as confirmed by the series of Doornberg et al. Radial Head Fracture 3. Outcomes after terrible triads of the elbow treated with the current surgical . -Begin gentle PROM and continue AROM/AAROM to elbow extension and !exion starting at 4 weeks. 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