Long-term functional outcomes of the terrible triad of the elbow

Introduction: The published literature regarding the terrible triad of the elbow has historically shown a high rate of unacceptable outcomes. The objective of the present study was to evaluate the long-term functional outcomes and repercussions in patients who suffered the terrible triad of the elbow. Material and methods: A retrospective analysis of a prospectively-recruited consecutive series of cases registered from August 2005 to August 2009, involving 27 patients from which 16 complied with inclusion criteria for the study. The mean follow-up period was 8.6 years (range: 6.9 to 10.6). Two different final quality of life evaluation questionnaires were performed by telephone: the EuroQol Five Dimensions Questionnaire (EQ-5D) and the patient answered questionnaire portion of the Liverpool Elbow Score (PAQ-LES). Results: Fifteen (93.7%) patients were intervened surgically whereas only 1 case was treated conservatively. EQ-5D-rated outcome averaged 0.87 (range: 0.36 to 1) and the PAQ-LES averaged 33.5 (range: 17 to 36). Five (31.2%) presented pain or discomfort, 4 (25.0%) had some kind of difficulties in their daily activity and 3 (18.7%) founded some limitations with their personal hygiene. Only 6 cases (37.5%) declared to be fully asymptomatic. Conclusion: The terrible triad of the elbow remains a challenging injury that entails the presence of chronic pain and discomfort in almost one third of the cases at a long-term follow-up

Surgical anatomy and technique for the treatment of Dubberley type 1, 2 and 3 capitellar fractures via a limited anterior approach to the elbow

Coronal plane fractures of the elbow can affect the capitellum, the trochlea (or a combination of the two), the radial head and the coronoid processes.The Kocher lateral approach is the most commonly used for open reduction of this type of fractures, although an arthroscopic technique has been used in some cases. When the fracture extends to the trochlea, the Kocher lateral approach may be inadequate for the correct visualisation, reduction and fixation of the fracture. In such cases an associated medial elbow approach may be required, or a posterior transolecranon approach may be preferred. We think that the limited anterior approach to the elbow could be a valid option when treating these types of fractures, as it does not involve the de-insertion of any muscle group or ligament, thereby facilitating the recovery process. In cases involving trochlear fracture (which may or may not be dissociated) the approach can be extended medially. We can also treat associated injuries such as fractures of the radial head or coronoid process with this approach. In the present study we describe the dissection of the medial and lateral cubital fossa of the elbow in extension in 4 specimens, paying attention to the neurovascular structures of the area. We also describe the surgical technique for the limited approach to the medial and lateral cubital fossa. We demonstrate the accessibility via the cubital fossa to the capitellum, trochlea, radial head, and coronoid process