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Posterior (Boyd) approach to terrible triad injuries
BACKGROUND: A ‘terrible triad injury of the elbow’ (TTIE) refers to an injury pattern involving posterior dislocation of the ulnohumeral joint, fracture of the radial head, and fracture of the coronoid process of the ulna. It is a complex injury to the elbow joint and can result in long-term elbow i...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8888163/ https://www.ncbi.nlm.nih.gov/pubmed/35252933 http://dx.doi.org/10.1016/j.jseint.2021.11.011 |
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author | Carroll, Patrick J. Morrissey, David I. |
author_facet | Carroll, Patrick J. Morrissey, David I. |
author_sort | Carroll, Patrick J. |
collection | PubMed |
description | BACKGROUND: A ‘terrible triad injury of the elbow’ (TTIE) refers to an injury pattern involving posterior dislocation of the ulnohumeral joint, fracture of the radial head, and fracture of the coronoid process of the ulna. It is a complex injury to the elbow joint and can result in long-term elbow instability, pain, stiffness, and arthritis. In specific cases, it may be treated conservatively, but in most circumstances, surgical stabilization is advised. The ‘drop sign’ is an objective static radiographically measured ulnohumeral distance of ≥4 mm seen intraoperatively and postoperatively. Although controversial, it may portend postoperative instability and arthritis. The senior author repairs these injuries in a standardized fashion through a modified Boyd rather than a lateral approach. Our aim was to assess the number of cases demonstrating an intraoperative drop sign after surgical treatment of a TTIE with this approach. METHODS: We retrospectively analyzed 22 consecutive patients with 23 acute TTIEs. These injuries were treated by a single surgeon using a modified Boyd (posterior) approach to the elbow. Intraoperative image intensifier x-rays were analyzed by the two authors to assess for a ‘drop sign’. RESULTS: None of the 23 cases had ‘drop signs’ on intraoperative imaging after stabilization. No patient has redislocated, underwent reoperation, or had symptoms of instability at follow-up. CONCLUSION: None of our patient cohort had an intraoperative ‘drop sign’ after standardized stabilization for a TTIE injury using a modified Boyd approach. |
format | Online Article Text |
id | pubmed-8888163 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-88881632022-03-03 Posterior (Boyd) approach to terrible triad injuries Carroll, Patrick J. Morrissey, David I. JSES Int Elbow BACKGROUND: A ‘terrible triad injury of the elbow’ (TTIE) refers to an injury pattern involving posterior dislocation of the ulnohumeral joint, fracture of the radial head, and fracture of the coronoid process of the ulna. It is a complex injury to the elbow joint and can result in long-term elbow instability, pain, stiffness, and arthritis. In specific cases, it may be treated conservatively, but in most circumstances, surgical stabilization is advised. The ‘drop sign’ is an objective static radiographically measured ulnohumeral distance of ≥4 mm seen intraoperatively and postoperatively. Although controversial, it may portend postoperative instability and arthritis. The senior author repairs these injuries in a standardized fashion through a modified Boyd rather than a lateral approach. Our aim was to assess the number of cases demonstrating an intraoperative drop sign after surgical treatment of a TTIE with this approach. METHODS: We retrospectively analyzed 22 consecutive patients with 23 acute TTIEs. These injuries were treated by a single surgeon using a modified Boyd (posterior) approach to the elbow. Intraoperative image intensifier x-rays were analyzed by the two authors to assess for a ‘drop sign’. RESULTS: None of the 23 cases had ‘drop signs’ on intraoperative imaging after stabilization. No patient has redislocated, underwent reoperation, or had symptoms of instability at follow-up. CONCLUSION: None of our patient cohort had an intraoperative ‘drop sign’ after standardized stabilization for a TTIE injury using a modified Boyd approach. Elsevier 2021-12-23 /pmc/articles/PMC8888163/ /pubmed/35252933 http://dx.doi.org/10.1016/j.jseint.2021.11.011 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Elbow Carroll, Patrick J. Morrissey, David I. Posterior (Boyd) approach to terrible triad injuries |
title | Posterior (Boyd) approach to terrible triad injuries |
title_full | Posterior (Boyd) approach to terrible triad injuries |
title_fullStr | Posterior (Boyd) approach to terrible triad injuries |
title_full_unstemmed | Posterior (Boyd) approach to terrible triad injuries |
title_short | Posterior (Boyd) approach to terrible triad injuries |
title_sort | posterior (boyd) approach to terrible triad injuries |
topic | Elbow |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8888163/ https://www.ncbi.nlm.nih.gov/pubmed/35252933 http://dx.doi.org/10.1016/j.jseint.2021.11.011 |
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