Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping review
Background: The terrible triad injury (TTI) of the elbow is a combination of a posterolateral dislocation of the elbow joint combined with fractures of the radial head and coronoid process most often caused by a fall on an outstretched hand. The injury pattern was named for its poor outcomes and hig...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-05-01
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| Series: | JSES Reviews, Reports, and Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666639122000104 |
| _version_ | 1818441068870369280 |
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| author | Thomas Stambulic Veeral Desai, BHSc Ryan Bicknell, MD Parham Daneshvar, MD |
| author_facet | Thomas Stambulic Veeral Desai, BHSc Ryan Bicknell, MD Parham Daneshvar, MD |
| author_sort | Thomas Stambulic |
| collection | DOAJ |
| description | Background: The terrible triad injury (TTI) of the elbow is a combination of a posterolateral dislocation of the elbow joint combined with fractures of the radial head and coronoid process most often caused by a fall on an outstretched hand. The injury pattern was named for its poor outcomes and high complication rates following surgical repair, but increased understanding of elbow anatomy and biomechanics has led to the development of standardized surgical protocols in an attempt to improve outcomes. Most existing literature on terrible triad injuries is from small retrospective cohort studies and surgical techniques to improve outcomes. Therefore, the purpose of this scoping review is to provide an overview of the functional outcomes, prognosis, and complications following current surgical treatment of TTIs. Methods: A scoping review was performed to evaluate the literature. In total, 617 studies were identified and screened by 2 reviewers, with 43 studies included for qualitative analysis. These 43 studies underwent data extraction for functional outcomes using the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder, and Hand score (DASH) and were stratified accordingly. Secondary outcome measures assessed in the study were a range of motion (ROM) and complication rate. Results: The average MEPS was 90 (excellent) from a total of 37 studies with 1609 patients, and the average DASH score was 16 from 16 studies with 441 patients. Another 6 studies with a total of 127 patients reported a mean Q-DASH score of 13. A total of 39 studies consisting of 1637 patients had a mean forearm rotation of 135 degrees, and 36 studies consisting of 1606 patients had a mean flexion-extension arc of 113 degrees. Among the studies, there was a 30% complication rate with a need for revision surgery in 7.8% of cases. The most common complications were radiographic evidence of heterotopic ossification (11%) and ulnar nerve neuropathy (2.6%). Discussion/Conclusions: This study shows that current surgical treatment for terrible triad injuries has resulted in improved outcomes. Based on primary outcome measures using MEPS and DASH scores, almost all of the studies have highlighted good or excellent functional outcomes. This highlighted the marked improvement in outcome scores since the term was coined, suggesting that terrible triad injuries may no longer be so terrible. |
| first_indexed | 2024-12-14T18:22:23Z |
| format | Article |
| id | doaj.art-844dccc00f684cf89afd0bff4db66205 |
| institution | Directory Open Access Journal |
| issn | 2666-6391 |
| language | English |
| last_indexed | 2024-12-14T18:22:23Z |
| publishDate | 2022-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES Reviews, Reports, and Techniques |
| spelling | doaj.art-844dccc00f684cf89afd0bff4db662052022-12-21T22:52:02ZengElsevierJSES Reviews, Reports, and Techniques2666-63912022-05-0122214218Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping reviewThomas Stambulic0Veeral Desai, BHSc1Ryan Bicknell, MD2Parham Daneshvar, MD3School of Medicine, Queen's University, Kingston, ON, CanadaSchool of Medicine, Queen's University, Kingston, ON, CanadaDepartment of Othopaedic Surgery, Queen's University, Kingston, ON, CanadaDepartment of Othopaedic Surgery, Queen's University, Kingston, ON, Canada; Corresponding author: Parham Daneshvar, MD, Division of Orthopaedic Surgery – Victory 3, Department of Surgery, Kingston Health Sciences Centre, 76 Stuart St, Kingston, Ontario, K7L2V7, Canada.Background: The terrible triad injury (TTI) of the elbow is a combination of a posterolateral dislocation of the elbow joint combined with fractures of the radial head and coronoid process most often caused by a fall on an outstretched hand. The injury pattern was named for its poor outcomes and high complication rates following surgical repair, but increased understanding of elbow anatomy and biomechanics has led to the development of standardized surgical protocols in an attempt to improve outcomes. Most existing literature on terrible triad injuries is from small retrospective cohort studies and surgical techniques to improve outcomes. Therefore, the purpose of this scoping review is to provide an overview of the functional outcomes, prognosis, and complications following current surgical treatment of TTIs. Methods: A scoping review was performed to evaluate the literature. In total, 617 studies were identified and screened by 2 reviewers, with 43 studies included for qualitative analysis. These 43 studies underwent data extraction for functional outcomes using the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder, and Hand score (DASH) and were stratified accordingly. Secondary outcome measures assessed in the study were a range of motion (ROM) and complication rate. Results: The average MEPS was 90 (excellent) from a total of 37 studies with 1609 patients, and the average DASH score was 16 from 16 studies with 441 patients. Another 6 studies with a total of 127 patients reported a mean Q-DASH score of 13. A total of 39 studies consisting of 1637 patients had a mean forearm rotation of 135 degrees, and 36 studies consisting of 1606 patients had a mean flexion-extension arc of 113 degrees. Among the studies, there was a 30% complication rate with a need for revision surgery in 7.8% of cases. The most common complications were radiographic evidence of heterotopic ossification (11%) and ulnar nerve neuropathy (2.6%). Discussion/Conclusions: This study shows that current surgical treatment for terrible triad injuries has resulted in improved outcomes. Based on primary outcome measures using MEPS and DASH scores, almost all of the studies have highlighted good or excellent functional outcomes. This highlighted the marked improvement in outcome scores since the term was coined, suggesting that terrible triad injuries may no longer be so terrible.http://www.sciencedirect.com/science/article/pii/S2666639122000104Terrible triadRadial head fractureCoronoid process fractureElbow fracture-dislocationMayo Elbow Performance ScoreDisabilities of the Arm |
| spellingShingle | Thomas Stambulic Veeral Desai, BHSc Ryan Bicknell, MD Parham Daneshvar, MD Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping review JSES Reviews, Reports, and Techniques Terrible triad Radial head fracture Coronoid process fracture Elbow fracture-dislocation Mayo Elbow Performance Score Disabilities of the Arm |
| title | Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping review |
| title_full | Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping review |
| title_fullStr | Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping review |
| title_full_unstemmed | Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping review |
| title_short | Terrible triad injuries are no longer terrible! Functional outcomes of terrible triad injuries: a scoping review |
| title_sort | terrible triad injuries are no longer terrible functional outcomes of terrible triad injuries a scoping review |
| topic | Terrible triad Radial head fracture Coronoid process fracture Elbow fracture-dislocation Mayo Elbow Performance Score Disabilities of the Arm |
| url | http://www.sciencedirect.com/science/article/pii/S2666639122000104 |
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