To explore the results of terrible triad of the elbow treated with surgical intervention.

This retrospective study included 25 cases of elbow joint triad of patients undergoing surgery in Huizhou Center People’s Hospital from May 2011 to September 2016. All the patients were identified with high-energy injury and traumatic history such as high fall and car accident injury. X-ray and CT examination of elbow dislocation, combined with radial head fracture and ulnar coronoid process fracture and surgical treatment. Patients who combined with serious combined injuries, shock, multiple fracture, rheumatoid elbow arthritis, lupus erythematosus, benign and malignant bone tumors, spinal cord injury affecting upper limb function, with poor compliance and withdrawal from the study were excluded. The mean age of patients at surgery was (35±10) years in 20 men and five women. The Mayo score and the Broberg-Morrey score were used to evaluate the elbow function postoperatively. Paired-t test and Fisher exact probability method was used.

At the last follow-up in March 2018, all the fractures healed at (16±5) weeks. The range of rotation of the forearm was (73±9)° preoperatively and (121±8)° postoperatively (t=21.619, P<0.001). The range of motion of the elbow joint was (63±8)° before surgery and (108±10)° postoperatively (t=17.879, P<0.001). According to Mayo score of elbow joint, there were 14 cases of excellent, five cases of good, four cases of fair and two poor cases, excellent and good rate was 76%. According to Broberg-Morrey elbow joint function score, there were excellent in 12 cases, good in eight cases, fair in three cases and poor in two cases, the excellent and good rate was 80%. The excellent and good rate of elbow joint function of patients with operation time <3 d, 3-14 d, >14 d were 98%, 60%, 25%, respectively (P=0.011). The excellent and good rate of elbow joint function in patients with ulna coracoid process fracture of type I, II and III were 94%, 50% and 45%, respectively (P=0.016). The excellent and good rate of postoperative elbow joint function in patients with type I, II and III of capitulum radial fracture were 94%, 40%, 33% (P=0.006). The excellent and good rate of elbow joint function in patients with internal and external combined approach and simple lateral elbow approach was 89%, 43% respectively (P=0.032). The excellent and good elbow joint function of patients with braking time less than two weeks, between two and four weeks, more than four weeks were 93%, 67%, 25%, respectively (P=0.013).

Surgical treatment is important for terrible triad of the elbow, the postoperative recovery of elbow function is closely related to the average time of injury to surgery, the fracture type of the radial head and coronoid process, the surgical approach and the in mobilzation time.