Work

Surgical Outcomes of Terrible Triad Injuries of the Elbow in a Resource-Limited Setting: A Consecutive Case Series

Year: 2026

Type: article

Abstract: Purpose To evaluate surgical outcomes of acute terrible triad injuries of the elbow treated without radial head prostheses or hinged external fixation and to identify factors associated with recovery in a resource-limited setting. Methods We retrospectively reviewed 30 of 151 eligible adults treated surgically between January 2021 and June 2024 at a tertiary trauma center in Vietnam. Mean follow-up was 13.9 ± 8.9 months. Outcomes included Mayo Elbow Performance Score (MEPS), Subjective Elbow Value, range of motion, radiographic findings, instability, and complications. Radial head fixation was performed in 66.7%, excision in 13.3%, coronoid fixation in 80%, lateral collateral ligament repair in 73.3%, and medial collateral ligament (MCL) repair in 33.3%. Results Mean MEPS was 81.2 ± 13.9, with 76.7% achieving good-to-excellent outcomes. Overall instability occurred in 40%, while concentric reduction was maintained in 73.3% and subluxation occurred in 26.7%. Radial head nonunion occurred in 15% of fixation cases. Radial head excision without MCL repair was associated with increased valgus carrying angle, while supervised physiotherapy was associated with a smaller extension deficit. No deep infections or reoperations were recorded. However, 3 of 18 patients treated with trans-humeral K-wires (16.7%) sustained iatrogenic olecranon fractures. Radiographic arthritis occurred in 50%. Conclusions Acceptable short-term functional outcomes can be achieved despite limited implant availability, but instability and radiographic complications remain substantial. Given the 19.9% follow-up rate, findings should be interpreted cautiously because of potential selection bias. Radial head preservation and MCL repair when excision is unavoidable are recommended, while trans-humeral K-wire stabilization should be used selectively. Type of study/level of evidence Therapeutic IV.

Source: Journal of Hand Surgery Global Online

DOI: 10.1016/j.jhsg.2026.101166

Authors: Hoa Thi My Pham, Hung Phuoc Do, Thy Gia Anh Le

Institutions: Hospital for Traumatology and Orthopedics, University of Medicine and Pharmacy at Ho Chi Minh City

Language: English

Topic: Elbow and Forearm Trauma Treatment

Subfield: Rehabilitation

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,500