Surgical treatment of the “terrible triad” of the elbow: long-term outcomes at 5 years’ follow-up

BACKGROUND: Terrible triad (TT) is one of the most challenging pattern of elbow injuries to treat and it often yields to severe complications. The aim of this study was to evaluate clinical and functional outcomes in 28 patients treated at our center from January 2011 to april 2019. METHODS: Fracture patterns, surgical technique and residual elbow instability, range of motion (ROM), grip and pinch strength were evaluated in all patients. Functional outcomes were assessed by Mayo elbow performance score (MEPS), disability of arm and shoulder and hand score (DASH) and visual analogue scale (VAS). Radiographic follow-up (FU) was possible in 18 patients to check heterotopic bone formation and arthritic changes. the mean FU was 60 months (range, 12-108). RESULTS: At the last FU a decreased ROM was observed in all patients compared to the contralateral elbow (an average of 7° in flexion, 15° in extension, 7.2° in supination, 5.2° in pronation), however only four of them (14%) had a functional limitation. also reduction of mean grip strength was observed (mean 5.11 kg, p=0.011). No elbow instability was detected at the last FU. After treatment, six minor and seven major complications were found; the major ones required second surgery. However mean Meps, dash and Vas were still satisfying. CONCLUSIONS: The surgical treatment of the tt of the elbow provides overall satisfactory results, although a considerable number of complications still persist and need to be addressed in the future