With Morrey type II and type III coronoid process fractures, fixation to the coronoid process in an adverse direction with two or three lag screws is recommended. Most terrible triad elbow injuries are managed surgically. Unhappy Triad Recovery: Months 4-7. O’Driscoll classification for coronoid process fractures: Type I, transverse fractures of the coronoid tip in which the fracture lines are confined to the coronoid tip; Type II, fractures of the anteromedial facet in which the fracture lines run past the coronoid tip and the anteromedial facet; and Type III, large fractures involving ≥50% of the coronoid height in which the fracture lines travel into the body and basal part of the coronoid. concluded that preservation of the radial head is important for both acute and long‐term stability and that radial head excision should be performed only in patients with grossly comminuted fractures or with low demands on their upper extremities. Epidemiology. 2017 Nov-Dec;25(6):283-286. doi: 10.1590/1413-785220172506168821. As a result, they are often seen by physical therapists for rehabilitation. NIH Computed tomography with three dimensional reconstructions can be helpful in ascertaining the type of injury. 'Terrible triad' is a term used to describe a severe complex dislocation with intra-articular fractures of the radial head and coronoid process. Hotchkiss introduced this concept 19965; Zhang et al. Physical therapy (or physiotherapy) literally means “attempted remediation of a health problem that is related to the body (as opposed to the mind).” It involves the use of exercises, assistive devices and other methods (such as massage or electrotherapy) for the preservation, enhancement or restoration of movement and physical function. Zhang et al. Terrible triad injuries account for approximately 30% of all elbow dislocations. The terrible triad is an uncommon injury, which includes an elbow posterior dislocation with fractures of the radial head and coronoid process of the ulna. In the realm of orthopaedics, the terrible triad of the elbow is infamous, not simply because the prognosis is poor for most patients, but also, maybe to a greater extent, because the unique name of this malady attracts considerable attention and interest in both doctors and patients. The stability of the elbow largely depends on the functions of the radial head, coronoid process of the ulnar, LCLC and anterior medial collateral ligament3. 3), and is often associated with collateral ligaments injuries. Proposed algorithms on how to optimally manage these injuries are published in the surgeon and therapy literature to assist with the clinical decision-making process in diagnoses such as “terrible triad” injuries. Lastly, we shed light on the rationality of the designation “the terrible triad”. Rehabilitation considerations in the management of terrible triad injury to the elbow. 2A), whereas the LCLC is made up of four small ligaments: the lateral ulnar collateral ligament (LUCL), the lateral radial collateral ligament (LRCL), the annular ligament and the accessory lateral ligament2 (Fig. It is caused by high kinetic energy trauma, usually in young patients.10 In this series we observed that males were the majority, representing 64% of patients. Please enable it to take advantage of the complete set of features! Figure 5: considered that coronoid process fixation is unnecessary for Regan–Morrey type I and II fractures if elbow stability has already been achieved by radial head repair or replacement and reconstruction of the LUCL30. A physical therapist may demonstrate a variety of low-impact exercises designed to increase the strength and mobility of your elbow joint. This triad has long given orthopedic surgeons headaches. A review, Medial complex elbow dislocation: an unusual pattern of injury, Outcome of lateral humeral condylar mass fractures in children associated with elbow dislocation or olecranon fracture, Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. For unrepairable comminuted coronoid process fractures in which radial head resection is required, the resected radial head can be utilized to restore the coronoid process26-29. Stability should be evaluated intraoperatively after reconstruction. Bone destruction in the terrible triad injury: the terrible triad of the elbow is defined as a combination of radial head and ulnar coronoid process fractures and the dislocation of the elbow joint. Among the variety of disease designations, the terrible triad of the elbow looms large and is eye‐catching because the term “terrible” is rarely seen in medical terminology no matter how intimidatingly severity a disorder is. Therefore, patients and even doctors may harbor doubts about what this so‐called terrible triad is, just how terrible it is, and whether it is possible to achieve a satisfactory prognosis. MCLC repair or hinged external fixation is further required if there is still elbow instability after the standard protocol has been implemented. followed a standard protocol in 14 cases with 18.7 months follow‐up and reported that 71.4% of Mayo elbow performance scores, 78.6% of Broberg–Morrey scores and 78.6% of DASH scores reached the good level40. All four patients treated by resection of the radial head re‐dislocated after operative treatment, whereas four of the five patients who underwent radial head repair achieved satisfactory prognoses with follow‐up of two to seven years. Are fractures of the elbow medial surgical Approach were the first to it... Fixation and arthroplasty, coronoid process fractures have little impact on elbow stability has been should. 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