Executive Editor: Peter Trafton, Michael Baumgaertner

Authors: Peter Kloen, David Ring

Proximal forearm Fracture dislocation, radial head and/or coronoid (Terrible triad)

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Glossary

When the elbow dislocates, the joint capsule and ligaments are completely torn.

If there are no associated fractures the elbow is usually stable after reduction, and surgery is not helpful.

An elbow with a fractured radial head and an intact coronoid is at low risk of dislocating. However, deformity of the radial head can hinder forearm rotation.

If both the radial head and the coronoid are fractured, the elbow is at high risk of dislocating. Repair of the fractures will help stabilize the elbow.

Open reduction internal fixation
Indication summary Skill Equipment
Posterior dislocation with fractures of the radial head and coronoid and residual subluxation or recurrent dislocation after reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Advantages

  • Ensures the elbow remains located during functional aftertreatment
Hinged external fixation following ORIF
Indication summary Skill Equipment
Residual subluxation or repeat dislocation after open repair Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Advantages

  • Holds elbow reduced during early healing and mobilization

Disadvantages

  • Places nerves at risk
  • Cumbersome
  • Pin-track infections
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2018-04-30