The left elbow was aspirated under aseptic precautions and local anaesthetic was injected at the fracture site. 24 hours after the injury, the patient was taken to the operating room. Thus the diagnosis of the terrible triad was made for the right elbow.
It was outlined as a type I fracture in the Regan and Morrey classification. In the scan: we noted a subluxation of the ulnohumeral articulation, 2 displaced articular fragments of the radial head which matched up with a type II fracture in Mason classification, and a fracture of the coronoid tip which does not extend past the sublime tubercle. The right elbow X ray showed a displaced radial head fracture and a small triangular osseous fragment anterior to the ulnohumeral articulation visible in the lateral radiograph. It was a simple displaced anterolateral fragment less than 30% of the articular surface, which corresponds to a Mason II fracture. On the left side, we found a radial head fracture. Anteroposterior and lateral radiographs of both elbows were performed as well as computed tomography (Figure 1). In both sides, neurovascular examination was normal, the subtle palpation along the interosseus membrane was painless, and the distal radioulnar joints examination was unremarkable concerning tenderness or instability. In the left elbow, clinical findings have shown painful rotation of the forearm, especially with palpation of the radial head without block to forearm rotation or ligamentous instability. Physical examination revealed significant swelling with total functional impotence in the right elbow. He underwent manipulative reduction and the elbow was fixed in flexion with plaster. He was taken to the emergency room in the local hospital immediately with pain in both elbows and dislocation of the right elbow joint.
Case PresentationĪ 29-year-old military man, right-handed without medical history fell from his motorbike on a highway and landed on both outstretched hands. This unprecedented pattern of injury in a high-demanding patient raises high demands on the surgeon’s mastery of the anatomic complexity of the elbow as well as the surgical indications and rehabilitation issues. This is the first description of a bilateral radial head fracture with unilateral terrible triad. A complex elbow dislocation with associated radial head and coronoid process fractures was named the terrible triad by Hotchkiss. Radial head fractures account for 3% of all fractures and approximately 33% of all elbow fractures. Keywordsīilateral Elbow Injury Mason II Fracture Rehabilitation Program Terrible Triad Injury Treatment Indicationīilateral Elbow Injury articles Mason II Fracture articles Rehabilitation Program articles Terrible Triad Injury articles Treatment Indication articles Article Details Abbreviations:ĬT- Computed Tomography LCL- Lateral Collateral Ligament MCL- Medial Collateral Ligament MEPS- Mayo Elbow Performance Score ORIF- Open Reduction and Internal Fixation ROM- Range of Motion 1. Well adapted surgical indication followed by optimal rehabilitation program are the two keys to obtain good results. Bilateral radial head fracture with unilateral terrible triad injury is unprecedented. We have reached good results 2 years after the injury: The Mayo Elbow Performance Score was 100 for both elbows.Ĭonclusion: The few available data suggest that bilateral elbow injury involving a terrible triad occurs mainly in male young patient as a result of a high energy trauma. The patient underwent open reduction and internal fixation of the radial head with repair of the lateral collateral ligament for the right elbow while the left radial head fracture was treated by a short-term immobilization in a posterior splint. It raises questions regarding the mechanism of injury, the surgical indication and the rehabilitation program.Ĭase Presentation: We report a case of a 29-year-old man presenting a unilateral terrible triad injury of the right elbow and a left radial head fracture after he fell off his motorcycle. Bilateral radial head fracture with unilateral terrible triad injury is an unprecedented presentation. Background: The combination of coronoid process fracture, radial head fracture, and elbow dislocation has earned the moniker “terrible triad” by virtue of its challenging treatment and historically poor outcomes.
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