Terrible triad of the elbow and associated variants: a systematic review

An Atypical Presentation of Terrible Triad Injury in a Healthy 51-Year-Old Female Patient

A left elbow fracture-dislocation in a 51-year-old female patient following a backward fall at home presented with a comminuted radial head fracture, coronoid fracture, and ruptured collateral ligaments. The patient underwent open reduction and internal fixation (ORIF) with a long-arm splint. Post surgery, aggressive rehabilitation was initiated to restore the range of motion (ROM). Compared to previous reports, this case demonstrates successful management of a severe elbow injury with excellent short-term outcomes. This case highlights the occurrence of the terrible triad in a patient without significant comorbidities and a low-energy fall, as well as the importance of early intervention, proper imaging, and interprofessional collaboration in managing such rare presentations.

Variant of the terrible triad of the elbow, a CASE report with a review of the literature

INTRODUCTION

The terrible triad described by Hotchkiss in 1996 is a complex lesion of the elbow, following a trauma combining forced valgus and external rotation. It is a lesion that puts the elbow at risk of developing complications such as instability, stiffness, or synostosis of the proximal radio-cubital joint.

CASE REPORT

We report the case of a patient who suffered a closed trauma to the right elbow following a fall onto the palm of the hand with a valgus lateral rotation mechanism. The lesion assessment showed a B2 fracture of the distal humerus (AO classification) with a line splitting the capitulum in the frontal plane, a type 3 coronoid process fracture (Morrey/Odriscoll classification), and a posterolateral elbow dislocation. The surgical treatment followed the same principles as for the terrible triad, with a reconstruction of the lateral column by osteosynthesis of the humeral palate, followed by an internal approach for osteosynthesis of the coronoid process, with the restoration of a stable elbow without laxity in the frontal plane.

DISCUSSION

On the basis of the lesion mechanism, column theory, and the schematization of the constituent elements of elbow stability in a ring, certain lesions can be placed in the same box as the terrible triad of the elbow, which also complies with the same therapeutic implications.

CONCLUSION

Our observation underlines the possibility of the existence of lesions other than those described by Hotchkiss, which would have the same consequences: an unstable elbow with the risk of evolving into chronic instability or stiffness and whose management accepts the same management.