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

How to Tame the Terrible Triad of 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 of 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)