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Does the coronoid fracture in terrible triad injury always need to be fixed?
Yeong-Seub Ahn, M.D., Ph.D, Chonnm National University Hospital, Gwangju, Korea, Republic of (South), Seong-Hwan Woo, M.D., Chonnam National University Hospital, Gwangju, Korea, Republic of (South) and Myung-Sun Kim, M.D., Ph.D., Chonna National University Hospital, Gwangju, Korea, Republic of (South)

Background

The ideal treatment and whether fixation of coronoid process fractures is needed are still debated. We aimed to investigate if terrible triad injuries necessitate coronoid fracture fixation and evaluate if non-fixation treatments have similar efficacies and outcomes as fixation-treatments in cases of terrible triad injuries.

Materials and methods

From August 2011 to July 2018, 15 patients with acute terrible triad injuries without involvement of the anteromedial facet of coronoid process were included to evaluate the postoperative clinical and radiological outcomes (minimum follow-up of 20 months). According to preoperative height loss evaluation of the coronoid process and an intraoperative elbow stability test, seven patients underwent coronoid fracture fixation, and the other eight patients were treated conservatively. The elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), and modified Broberg-Morrey score were evaluated at the last follow-up. Plain radiographs were reviewed to evaluate joint congruency, fracture union, heterotopic ossification, and the development of arthritic changes.

Results

At the last follow-up, the mean arcs of flexion-extension and supination-pronation values were 122.1° and 153.9° in the fixation group and 124.1° and 157.8° in the non-fixation group, respectively. The mean MEPSs were 97.1 in the fixation group (excellent, six cases; good, one case) and 97.5 in the non-fixation group (excellent, seven cases; good, one case). The mean modified Broberg-Morrey scores were 93.8 in the fixation group (excellent, four cases; good, three cases) and 95 in the non-fixation group (excellent, seven cases; good, one case). No statistically significant differences in clinical scores and ROM were identified between the two groups. The non-fixation group showed a significantly lower height loss of the coronoid process than the fixation group (39.4% versus 54.2%).

Conclusions

In terrible triad injuries, there were no significant differences in clinical outcomes between the fixation and non-fixation groups.


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