Terrible Triad of the Elbow

Enhance your skills in managing the terrible triad of the elbow, a complex injury involving multifragmentary fracture of the radial head, avulsion of the coronoid process with compromise of the anterior joint capsule, and injury to the lateral collateral ligament. This training focuses on the reconstruction of the radial head, repair of the anterior joint capsule, and reinsertion of the lateral collateral ligament, three fundamental steps to restore stability and function of the elbow, allowing for early mobility in the postoperative period.

Training Focus:

• Reconstruction of multifragmentary fracture of the radial head (Mason 3).
• Repair of the anterior joint capsule and the avulsed coronoid process. avulsed.
• Reinsertion of the lateral collateral ligament.
• Restoration of stability and function of the elbow.
• Post-operative management with early mobility.

Detailed Content:

• Access via Kaplan: Incision based on the lateral epicondyle and dissection in the Kaplan interval up to the head of the radius, separating the annular ligament.
• Exposure and Ligamentous/Capsular Repair: Early repair of the annular ligament. Disinsertion and repair of the lateral collateral ligament. Identification of the fragment of the coronoid process in the anterior capsule.
• Osteosynthesis of the Radial Head: Four-part fracture with central impact; anatomical reduction with a spatula and fixation with 2.0 mm screws using a tripod technique within the safe zone.
• Reinsertion of the Anterior Capsule: Suture of the coronoid fragment with a positioned anchor. Traction of the capsule with high-strength wire, ensuring joint stability.
• Final Ligament Repair: Anatomical closure of the annular and lateral collateral ligaments with the aid of valgism for ideal tension and prevention of instability.
• Surgical Closure: Closure in layers at the Kaplan access, preserving anatomy and allowing early mobility.
• PPost-operative: Range of motion released immediately, except for extension (limited to 45°). Stability depends on anatomical reduction, not just fixation.