Olivier Bozon1, Sacha Chrosciany2, Marie Loisel3, Arthur Dellestable4, Laura Gubbiotti5, Raphaëlle Dumartinet-Gibaud6, Elise Obrecht7, Meagan Tibbo8, Clara Sos9, Pierre Laumonerie10. 1. Department of Orthopedics and Traumatology, Hôpital Lapeyronie, Montpelier, France. 2. Department of Orthopedics and Traumatology, Hôpital Dupuytren, Limoges, France. 3. Department of Orthopedics and Traumatology, Hôpital Pontchaillou, Rennes, France. 4. Department of Orthopedics and Traumatology, Hôpital Cavale Blanche, Brest, France. 5. Department of Orthopedics and Traumatology, Hôpital Côte de Nacre, Caen, France. 6. Department of Orthopedics and Traumatology, CHU, Angers, France. 7. Department of Orthopedics and Traumatology, Hôpital Charles Nicolle, Rouen, France. 8. Department of Orthopedics, Mayo Clinic, Rochester, MN, USA. 9. Department of Orthopedics and Traumatology, Hôpital Trousseau, Tours, France. 10. Department of Orthopedics and Traumatology, Hôpital Pellegrin, Place Amélie Raba-Léon, 33000, Bordeaux, France. pierre.laumonerie@chu-bordeaux.fr.
Abstract
PURPOSE: The aims of this study are to summarize (1) the history of terrible triad injury (TTi) treatment and (2) the clinical and biomechanical data that engendered its evolution. METHODS: A literature search was performed using five electronic databases. Results were discussed as a chronologic review of the relevant literature between 1920 and 2022. RESULTS: In 1962, Osborne was the first to describe a link between elbow dislocation, radial head fracture, and lateral collateral ligament complex injury via a novel mechanism: posterolateral rotatory instability (PLRI). Given that untreated elbow instability leads to post-traumatic osteoarthritis (PTOA), there has been increasing interest in elbow biomechanics since the 1980s. Data from studies in that period revolutionized the approach to elbow instability. The authors demonstrated that TTi could occur via a PLRI mechanism with a disruption of the lateral collateral ulnar ligament and a functionally competent anterior medial collateral ligament (aMCL). Since the 1990s, due to the difficulty in identifying its pathoanatomic features, some began to speculate about a sequence of injuries and mechanisms leading to TTi. However, the clinical literature has largely been unable to reproduce in vitro findings describing the pathomechanics of TTi. Some aspects of treatment remain controversial including systematic coronoid and aMCL repair. CONCLUSION: Despite a growing body of biomechanics data, there is no widely accepted surgical protocol for the treatment of TTi. Functional outcomes among patients have greatly improved. Better diagnosis and treatment of infra-clinical instability after a TTi may be an important stepping stone to prevent the onset of moderate/severe PTOA.
PURPOSE: The aims of this study are to summarize (1) the history of terrible triad injury (TTi) treatment and (2) the clinical and biomechanical data that engendered its evolution. METHODS: A literature search was performed using five electronic databases. Results were discussed as a chronologic review of the relevant literature between 1920 and 2022. RESULTS: In 1962, Osborne was the first to describe a link between elbow dislocation, radial head fracture, and lateral collateral ligament complex injury via a novel mechanism: posterolateral rotatory instability (PLRI). Given that untreated elbow instability leads to post-traumatic osteoarthritis (PTOA), there has been increasing interest in elbow biomechanics since the 1980s. Data from studies in that period revolutionized the approach to elbow instability. The authors demonstrated that TTi could occur via a PLRI mechanism with a disruption of the lateral collateral ulnar ligament and a functionally competent anterior medial collateral ligament (aMCL). Since the 1990s, due to the difficulty in identifying its pathoanatomic features, some began to speculate about a sequence of injuries and mechanisms leading to TTi. However, the clinical literature has largely been unable to reproduce in vitro findings describing the pathomechanics of TTi. Some aspects of treatment remain controversial including systematic coronoid and aMCL repair. CONCLUSION: Despite a growing body of biomechanics data, there is no widely accepted surgical protocol for the treatment of TTi. Functional outcomes among patients have greatly improved. Better diagnosis and treatment of infra-clinical instability after a TTi may be an important stepping stone to prevent the onset of moderate/severe PTOA.
Authors: Toni Luokkala; David Temperley; Subhasis Basu; Teemu V Karjalainen; Adam C Watts Journal: J Shoulder Elbow Surg Date: 2018-11-08 Impact factor: 3.019
Authors: David M W Pugh; Lisa M Wild; Emil H Schemitsch; Graham J W King; Michael D McKee Journal: J Bone Joint Surg Am Date: 2004-06 Impact factor: 5.284