Terrible triad injury of the elbow: a historical perspective,International Orthopaedics

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Terrible triad injury of the elbow: a historical perspective
International Orthopaedics ( IF 2.0 ) Pub Date : 2022-06-20 , DOI: 10.1007/s00264-022-05472-4
Olivier Bozon ₁ , Sacha Chrosciany ₂ , Marie Loisel ₃ , Arthur Dellestable ₄ , Laura Gubbiotti ₅ , Raphaëlle Dumartinet-Gibaud ₆ , Elise Obrecht ₇ , Meagan Tibbo ₈ , Clara Sos ₉ , Pierre Laumonerie ₁₀

Affiliation

Purpose

The aims of this study are to summarize (1) the history of terrible triad injury (TTi) treatment and (2) the clinical and biomechanical data that engendered its evolution.

Methods

A literature search was performed using five electronic databases. Results were discussed as a chronologic review of the relevant literature between 1920 and 2022.

Results

In 1962, Osborne was the first to describe a link between elbow dislocation, radial head fracture, and lateral collateral ligament complex injury via a novel mechanism: posterolateral rotatory instability (PLRI). Given that untreated elbow instability leads to post-traumatic osteoarthritis (PTOA), there has been increasing interest in elbow biomechanics since the 1980s. Data from studies in that period revolutionized the approach to elbow instability. The authors demonstrated that TTi could occur via a PLRI mechanism with a disruption of the lateral collateral ulnar ligament and a functionally competent anterior medial collateral ligament (aMCL). Since the 1990s, due to the difficulty in identifying its pathoanatomic features, some began to speculate about a sequence of injuries and mechanisms leading to TTi. However, the clinical literature has largely been unable to reproduce in vitro findings describing the pathomechanics of TTi. Some aspects of treatment remain controversial including systematic coronoid and aMCL repair.

Conclusion

Despite a growing body of biomechanics data, there is no widely accepted surgical protocol for the treatment of TTi. Functional outcomes among patients have greatly improved. Better diagnosis and treatment of infra-clinical instability after a TTi may be an important stepping stone to prevent the onset of moderate/severe PTOA.

中文翻译：

可怕的肘部三联征：历史视角

目的

本研究的目的是总结 (1) 可怕的三联征 (TTi) 治疗的历史和 (2) 产生其演变的临床和生物力学数据。

方法

使用五个电子数据库进行了文献检索。结果作为对 1920 年至 2022 年间相关文献的时间顺序回顾进行了讨论。

结果

1962 年，Osborne 首次通过一种新机制描述了肘关节脱位、桡骨头骨折和外侧副韧带复合体损伤之间的联系：后外侧旋转不稳 (PLRI)。鉴于未经治疗的肘部不稳定会导致创伤后骨关节炎 (PTOA)，自 1980 年代以来，人们对肘部生物力学的兴趣越来越大。那个时期的研究数据彻底改变了肘部不稳定的方法。作者证明，TTi 可能通过 PLRI 机制发生，破坏了外侧副尺骨韧带和功能正常的前内侧副韧带 (aMCL)。自 1990 年代以来，由于难以确定其病理解剖学特征，一些人开始推测导致 TTi 的一系列损伤和机制。然而，临床文献在很大程度上无法重现描述 TTi 病理机制的体外发现。治疗的某些方面仍然存在争议，包括系统性冠突和 aMCL 修复。