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Terrible Triad Injury or Complicated Triad Injury of Elbow: A Systematic Review

Author(s): Weijun Guo, Di Lu, Jiqi Wang, Peng Luo, Miao Liu, Youming Zhao

Objectives: To summarize the changes of outcomes and complications of terrible triad injury (TTI) in patients who were treated by current surgical strategies. Our hypothesis was that with the application of current surgical protocols, clinical results were improved and complications reducing. However, risks still persisted and new challenges came to affect the prognosis.

Methods: We performed a systemic review of PubMed, MEDLINE, EMBASE, the Web of Science and Cochrane Library to identify all relevant studies. Studies of TTI patients treated based on current surgical protocols after 2004 were included. Outcomes evaluated were functional scores, the range of motion and complications.

Results: Eleven studies with 166 patients were included. With a mean follow-up of 14.8 to 41 months, average flexion arc was ranged from 99° to 127° with average forearm rotation of 80° to 156°. Mean Mayo Elbow Performance Score was 78 to 96. Mean Broberg- Morrey Score was 76 to 90. The most frequent complications were heterotopic ossification (0 to 31%) and posttraumatic osteoarthritis (0 to 38%), followed by nerve symptoms, dislocation or subluxation and stiffness.

Conclusions: Functional outcome after surgery for TTI indicates that current surgical protocols made TTI less terrible as it used to be. However, challenges still persisted and remained it a troublesome injury to treat. Clinicians should pay more attention to surgery unrelated factors and prosthesis-related complications to improve the outcomes.

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