How to Tame the Terrible Triad of the Elbow Michael D. McKee, MD, - - PowerPoint PPT Presentation

How to Tame the Terrible Triad

• f the Elbow
• Michael D. McKee, MD, FRCS(C)
• Professor and Chair, Department of Orthopaedic Surgery
• University of Arizona, College of Medicine, Phoenix, AZ

Bony structures

• Bony congruity
• Coronoid process
• Radial head

SOFT TISSUE STRUCTURES

• Lateral (ulnar) collateral

ligament

• lateral epicondyle to tubercle
• f supinator crest on lateral

side of ulna

• posterior bundle most

important

• common injury in elbow

dislocation

• resists varus and rotational

stress

SOFT TISSUE STRUCTURES

• Medial (ulnar) collateral ligament
• medial epicondyle to tubercle on medial

aspect of coronoid

• Anterior band

most important

Stability

• The coronoid
• The lateral collateral ligament
• The radial head
• The medial collateral ligament

Surgical tactics

• Fix coronoid or repair anterior capsule
• Fix or replace the radial head (metallic,

modular)

• Repair the lateral collateral ligament / CEO
• Repair the medial collateral ligament
• Apply a hinged fixator

฀Coronoid fixation

ORIF / Replacement radial head

Avulsion from lateral condyle

McKee et. al. JSES 2003: pathoanatomy of lateral ligament disruption in complex elbow instability.

Surgical technique

1) Radial head fracture - ORIF 14

• replacement 23
• fragment excision 4

2) Coronoid fracture - ORIF 18 capsule repair 23 3) Soft-tissue repair - LCL (+/- CEO) 41

• MCL 6

4) Hinged external fixator - 9

Results

• Mean follow-up 14 months
• Mean flexion-extension arc 109˚
• Mean forearm rotation arc 127˚
• Mean Mayo elbow score: 89

(19 excellent, 14 good, 7 fair, 1poor)