We present the case of a unique association of the two injuries with an elbow dislocation, radial and coronoid process fractures and a distal radioulnar joint dislocation due to an interosseous membrane rupture. Terrible; elbow; fracture; instability; triad. The goal of physiotherapy is to reduce pain and swelling, restore your elbow’s full range of motion, and strengthen muscles. We used a TightRope device to stabilize the DRUJ as this tool enables forearm good ROM at the beginning of physical therapy, and there is no need to remove the device. He reported immediate swelling and pain in his elbow and wrist. A 56-year-old male fell forward onto his forearm and elbow during a mountain walk. Terrible triad of the elbow associates posterior dislocation, radial head fracture and coronoid process fracture. In patients who undergo treatment after the acute injury period, the coronoid may require reconstruction using radial head autograft, iliac crest autograft, olecranon autograft, or allograft. The elbow is a 3-dimensionally complex joint where stiffness is poorly tolerated and instability is devastating. In the past, most of these injuries were treated by manipulative reduction and cast immobilization.  |  terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation. This site needs JavaScript to work properly. The “terrible triad of the elbow” is a notorious combination of elbow dislocation and fractures of the coronoid process and radial head that has historically been difficult to manage and had an unsatisfactory prognosis 36-38, almost unavoidably causing long‐standing postoperative pain, elbow instability and a range of complications. NIH Epub 2018 Nov 6.  |  The 'terrible triad of the elbow' refers to a combination of elbow dislocation and radial head and coronoid process fracture - it is notoriously difficult to manage although a systematic review found that whilst complications are common, functional outcomes are generally satisfactory . In our case, the testing showed a stable elbow, so we decided not to fix the coronoid fracture furthermore that it was a small anteromedial fragment stage 2 according to the O’Driscoll classification. The unhappy triad is the name of a severe injury involving three crucial parts of your knee joint. 2020 Oct 29;9(11):3500. doi: 10.3390/jcm9113500. Distal arm pain should not simply be dismissed as referred pain [5]. In the elbow with persistent instability after repair of these elements, application of a static external fixation, hinged external fixation, ulnohumeral joint pinning, or an internal hinge … Faculté de medecine et de pharmacie de Marrakech, University Hospital Mohammed VI, Marrakech, Morocco. Keywords: 2014 Jul;472(7):2084-91. doi: 10.1007/s11999-014-3471-7. Pre-operatively on the ward • Discuss post -operative rehab ’ By Joaquin Sanchez-Sotelo 58 Videos. Zhou C, Lin J, Xu J, Lin R, Chen K, Sun S, Kong J, Shui X. Med Sci Monit. Jupiter and Ring JBJS 2002 . The Elbow Terrible Triad - Surgical Treatment. Consequently, each time a radial head fracture associated or not to an elbow dislocation is diagnosed, an ipsilateral wrist examination is mandatory to diagnose an Essex-Lopresti injury; otherwise, chronic wrist symptoms can develop, such as pain and instability [4]. We present a particular case by the unique association of two rare injuries: a terrible triad of the elbow and an ipsilateral Essex-Lopresti entity. Chan K, MacDermid JC, Faber KJ, King GJ, Athwal GS. Shoulder Elbow. Surgical treatment for terrible triad injury of the elbow with anteromedial coronoid fracture through a combined surgical approach J Int Med Res . The objective of this systematic review was to summarize the most recent available evidence regarding functional outcomes and complications … Objective Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. Protection of the ligament repair is essential. Surgical management is quite standardized according to Pugh et al. The syndrome of “terrible triad of the elbow”, which was first described by Hotchkiss in 1996 1 , is a severe pattern of elbow fracture‐dislocation injury that consists of posterior dislocation of the elbow associated with fractures of the radial head and the coronoid process of the ulna. The aim is a stable concentrically guided elbow with early functional follow-up treatment. 2013 Apr;27(4):496-9. Abstract. Resection of radial head alone is contraindicated. Algorithm for surgical treatment of terrible triad elbow injuries. The elbow was stable, and the grip strength was comparable to the contralateral side (Fig. Understanding the Cervical kyphosis: A predominant feature of patients with osteogenesis imperfecta type 5. (ii) Repair of the anterior column: by suture of the anterior capsule or fixation of coronoid process. Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad. Whereas the importance of early recognition of neurovascular compromise is well described and nearly universally recognized, the importance of timely and correct treatment in preventing delayed complications and potential instability is often less emphasized in the radiology literature. (A) X-ray of elbow profile shows the posterior elbow dislocation with a detached anterior fragment from the coronoid; (B) three-fourth X-ray of the forearm before the reduction demonstrates significant ulnar negative variance. Clin Orthop Relat Res. The DRUJ and PRUJ dislocations were suggestive of a complete disruption of the interosseous membrane. Clin Orthop Relat Res. Faculté de Medecine et de Pharmacie de Marrakech. On examination, there was a deformity of his right elbow with pain in the ipsilateral wrist; there were no skin or distal neurovascular disorders. Previous studies have demonstrated elbow instability and posttraumatic arthrosis following resection of the radial head in complex elbow dislocations . Epub 2017 Jun 13. 2019 Dec;11(6):450-458. doi: 10.1177/1758573218809375. Does Timing of Surgery Affect Treatment of the Terrible Triad of the Elbow? Outcomes following surgical management of complex terrible triad injuries of the elbow: a single surgeon case series. Radial head fixation and arthroplasty, coronoid process fixation, and repair of the lateral collateral ligament continue to be the mainstays of treatment. [Selective neurotization of the median nerve in young patients with CV-CVIIcomplicated spinal cord injury]. When the radial head fracture is accompanied by an interosseous membrane lesion affecting the distal radioulnar joint (DRUJ), it is given the name Essex-Lopresti injury [ 4 ]. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, A rare case of fat embolism syndrome secondary to abdominal liposuction and gluteal fat infiltration, The use of radiolucent (carbon fibre-reinforced polymer) pedicle screw fixation for serial monitoring of clear cell meningioma: a case report, Type A aortic dissection after ‘zone 0’ thoracic endovascular aortic repair for type 1 hybrid aortic arch replacement of arch aneurysm, Spontaneous intestinal bleeding due to pseudoaneurism of the gastroduodenal artery: case report of a rare complication to median arcuate ligament syndrome, Two cases of giant peritoneal inclusion cysts requiring treatment after total laparoscopic hysterectomy, Volume 2020, Issue 12, December 2020 (In Progress), http://creativecommons.org/licenses/by-nc/4.0/, Receive exclusive offers and updates from Oxford Academic, Paediatric medial epicondyle fracture without elbow dislocation associated with intra-articular ulnar nerve entrapment, A rare case of Elbow dislocation with medial epicondyle fracture associated to ulnar neuropraxia, A rare three part proximal ulnar shear fracture requiring innovative reduction and fixation in a paediatric elbow, Desmoplastic fibroma of the distal radius: an interesting case and a review of the literature and therapeutic implications. The purpose of treatment in the terrible triad injury is to restore the congruency of the elbow joint, its stability and an optimal ROM. - Terrible triad injury of the elbow: how to improve outcomes? 2014 Jul;472(7):2128-35. doi: 10.1007/s11999-013-3331-x. Some of the most common injury classification systems cited in t… The elbow testing objected a stable elbow from −30° of extension to complete flexion. J Clin Med. Terrible triad … COVID-19 is an emerging, rapidly evolving situation. In some accidents, the elbow dislocates (the radius and ulna are pulled apart from the humerus) without any bones breaking; surgeons call this injury a “simple dislocation”. 3D reconstruction CT scan of the elbow shows a radioulnar proximal dislocation with O’Driscoll type 2-2 anteromedial fracture. The terrible triad of the elbow is posterior or posterolateral dislocation of the ulnohumeral joint with fractures of the radial head and coronoid process. 20:08. This course of physical therapy successfully treat a undisplaced terrible triad injury in very limited selected supervised patients. Early management is a favourable prognostic factor for final outcome. We report on the diagnostic and treatment challenge of this unique case. Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. © The Author(s) 2020. Hotchkiss RN. The stability was rechecked and upgrade of the stable range of motion (ROM) was assessed, the elbow was now stable from −20° extension to complete flexion. 2016 Jul 25;29(7):677-680. doi: 10.3969/j.issn.1003-0034.2016.07.021. In: Jungbluth P, Frangen TM, Arens S, Muhr G, Kälicke T. Pugh DM, Wild LM, Schemitsch EH, King GJ, McKee MD. Bilateral elbow dislocation in relation to Essex-Lopresti injury. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? 4 and 5). As emergency treatment, we realized a closed reduction of the elbow dislocation under general anaesthesia with X-ray control, the limb was stabilized in a posterior brachiopalmar splint. - Management of Complex Elbow Dislocations: - dislocation w/ radial head frx - terrible triad - Complications: - valgus instability: - patients will show a variable amount of MCL laxity which correlates with a worse clinical and radiographic result; - to maximize the stress on the medial collateral ligament, the forearm should be placed in full pronation, which Clipboard, Search History, and several other advanced features are temporarily unavailable. Please enable it to take advantage of the complete set of features! Surgical technique - Treatment strategy of terrible triad of the elbow: Experience in Shanghai 6th People's Hospital. The treatment of terrible triad injuries of the elbow continues to evolve. Treatment of terrible triad injuries at a mean follow-up of nine years. The “terrible triad” injury is classically described as a combination of a coronoid process and radial head fractures, as well as a posterolateral elbow dislocation. According to that elbow stability status and the coronoid fracture stage, we decided a conservative treatment for the anteromedial coronoid fracture. The elbow dislocation is a frequent and an easily diagnosed pattern, at the opposite of the DRUJ dislocation, which is often missed in the emergency department if an adequate physical exam with the appropriate radiographs is not carried out [3]. Characteristics/Clinical Presentation 2014 Jul;472(7):2092-9. doi: 10.1007/s11999-014-3518-9. 5 patients: dislocated for 2 to 9 months . A Kaplan approach was used to reduce the PRUJ dislocation, the annulate ligament was repaired and the radial head fracture was evaluated, as the detached fragment was <20% of the radial head circumference, no fixation was necessary. An elbow dislocation associated with a displaced fracture of the radial head and coronoid process almost always renders the elbow unstable, making surgical fixation necessary. The terrible triad refers to three combined lesions: elbow dislocation, radial head and coronoid fractures [2, 3]. Radial head fixation and arthroplasty, coronoid process fixation, and repair of the lateral collateral ligament continue to be the mainstays of treatment. The terrible triad of the elbow and the Essex-Lopresti are two rare injuries but their association is unique [1, 2]. 1A). 3). Closed reduction of the DRUJ was achieved but it was instable, a fixation with a TightRope was used (Fig. HHS Shoulder Elbow. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. Free active assisted flexion, free extension to -30 deg off full extension, lying with shoulder 90 deg of abduction. AIM OF SURGERY: Reconstruction of the most important ligamentous and osseus structures of the elbow after terrible triad injury via the radial head to the lateral collateral ligament complex (LCL) and if necessary beginning at the coronoid process. The terrible triad includes a posterior dislocation of the elbow with radial head and coronoid fractures, concurrent ligament injuries are very common especially the LCL and medial collateral ligament (MCL), which can be the source of a definite instability [1, 2]. Terrible triad of the elbow and the Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome. Unfallchirurg. Other names for it include: terrible triad; O’Donoghue’s triad Login to view comments. [Progress in treatment of terrible triad of elbow]. 1B). Published by Elsevier Inc. All rights reserved. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. The use of a hinged external protection is recommended as it allows quick articular mobilization [8]. This may be done as below, or in a hinged range of motion brace or x-fix if applied. The distal radioulnar dislocation should also be reduced by placing the forearm in maximum supination and stabilized either with a brachiopalmar splint, a percutaneous Kirschner wire, repairing the triangular ligament or the central band of the interosseous membrane [10]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. should instability persist after addressing the radial head and the LCL complex in the presence of a small coronoid fracture, the next best step is MCL reconstruction. Treatment of the terrible triad injury of the elbow remains a difficult problem. Zhongguo Gu Shang. 1 Introduction Fracture dislocation of the elbow , termed terrible triad , involves three anatomic injuries: coronoid fracture, radial head fracture , and posterior elbow dislocation. 2013. USA.gov. Additionally, it restores the lateral column of the elbow, acting to tension the repaired lateral ligaments resisting varus and posterolateral rotatory instability. A study [9] has shown that coronoid fractures do not need to be fixed if there is stability in the ROM after repair of lateral structures. The lateral collateral ligament (LCL) and the common extensor muscle were repaired. The case was managed with closed reduction of the elbow dislocation and distal radioulnar joint followed by open reduction and repair of the damaged structures in the elbow and an unloading of the interosseous membrane. The terrible triad refers to three combined lesions: elbow dislocation, radial head and coronoid fractures [ 2, 3 ]. Does the Coronoid Always Need to Be Fixed in Terrible Triad Injuries of the Elbow? 2018 Jul 9;24:4745-4752. doi: 10.12659/MSM.907146. Chronic Simple Elbow Dislocation . Stable elbow, > 100 degrees motion in all patients The origins of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) complexes avulse from the epicondyles and the anterior capsule fails with a transverse fracture of the coronoid tip. [Progress on diagnosis and treatment of the terrible triad of elbow joint]. Initial lateral radiographs requested by the emergency doctor focused on the elbow and showed a posterior dislocation of the right elbow with a type II Mason radial head fracture with a small detached fragment <20%, associated to a proximal radioulnar joint (PRUJ) dislocation and a coronoid fracture type 2 according to the O’Driscoll classification with an anterior avulsion of an anteromedial coronoid small fragment (Fig. - Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. The authors declare there is no financial support from any organism. The Essex-Lopresti refers to an association of a radial head fracture dislocation, an interosseous membrane rupture and a DRUJ dislocation [3].  |  2018 Aug;46(8):3053-3064. doi: 10.1177/0300060518771263. Zaidenberg EE, Abrego MO, Donndorff AG, Boretto JG, De Carli P, Gallucci GL. Click here to Login. Elbow dislocations are staged depending on the disruption of the following stabilizers: the ulnohumeral articulation, MCL, and LCL. The goal of treatment for terrible triad injuries is restoring the bony anatomy and reconstructing the ligamentous restraints of the elbow to provide enough stability for early elbow range of motion and prevent elbow stiffness . (iv) Early elbow mobilization is started to avoid the stiffness. We managed a surgical treatment the second day of admission. 2017 Jul;120(7):595-610. doi: 10.1007/s00113-017-0373-7. No similar case has been found in the literature review. Clinical assessment of the post-operative ROM (A and B). It is a complex trauma, associating … A terrible triad combines three injuries: dislocation of the elbow, fracture of the radial head, and fracture of the coronoid. Mid-Term Postoperative Outcomes Following a Standardized Protocol. There was mild widening of the DRUJ with significant ulnar negative variance (Fig. Radial head replacement might be a more effective treatment approach with good clinical outcomes for patients with a terrible triad of the elbow. of “terrible triad of the elbow”, which was first described by Hotchkiss in 19961, is a severe pattern of elbow fracture-dislocation injury that consists of posterior dis- … Can we treat select terrible triad injuries nonoperatively? [6, 7]: (i) the humeroradial joint: LCL complex must be repaired in all cases eventually with the common extensor origin, radial head fractures are either treated functionally if minimally displaced, fixed, or if comminuted, replaced by an implant. 2018 Jul;10(3):216-222. doi: 10.1177/1758573217713694. In case of instability, whatever the height of the fragment, fixation is indicated [5]. 2). With recent developments in pathology, anatomy and biomechanics of the elbow … NLM National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. A computed tomography (CT) confirmed the stage 2 coronoid process fracture and a partial radial head fracture, the PRUJ dislocation was also demonstrated (Fig. A sling was used for comfort for 2 weeks postoperatively with physiotherapy and ROM exercises initiated early. What you’ve sustained is called the terrible triad injury, because you’ve broken your ulnar, radial head and also dislocated your entire elbow.’ A picture of this is below, and while I kinda just shrug my shoulders at it, anyone in the medical field just looks a bit uncomfortable and says ‘ouch’ when they see it, so I guess the gap in the bone is where I broke it. The treatment of terrible triad injuries of the elbow continues to evolve. Treatment: Open reduction and hinged external fixation . Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis? Elbow dislocation associated with both radial head and coronoid fractures, termed the “terrible triad injury” (TTI) by Hotchkiss [1], was notoriously challenging for decades because of the difficulties inherent in treatment and the consistently poor prognosis [2-4]. 'Terrible triad' is a term used to describe a severe complex dislocation with intra-articular fractures of the radial head and coronoid process. March 10, 2011 71 Comments . Watters TS, Garrigues GE, Ring D, Ruch DS. Zakaria Ramzi, Jordi Juanos Cabans, Harold Jennart, Terrible triad of the elbow with an ipsilateral Essex-Lopresti injury: case report, Journal of Surgical Case Reports, Volume 2020, Issue 6, June 2020, rjaa103, https://doi.org/10.1093/jscr/rjaa103. Tel: +212615994028; E-mail: Search for other works by this author on: Complex elbow dislocations and the “terrible triad” injury, An uncommon Essex-Lopresti fracture dislocation with radial displacement in distal direction: diagnosis and surgical treatment of a rare case, Longitudinal instability of the forearm: anatomy, biomechanics, and treatment considerations, Nonsurgically treated terrible triad injuries of the elbow: report of four cases, Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures, Terrible triad of the elbow: treatment protocol and outcome in a series of eighteen cases. Romero Pérez B, Marcos García A, Medina Henríquez JA, Muratore Moreno G. Oxford University Press is a department of the University of Oxford. Copyright © 2015 American Society for Surgery of the Hand. When the radial head fracture is accompanied by an interosseous membrane lesion affecting the distal radioulnar joint (DRUJ), it is given the name Essex-Lopresti injury [4]. "Terrible Triad" injury describes unstable joint consisting of: Elbow dislocation; Radial head fracture; Coronoid fracture; Clinical Features. If the elbow is unstable after repair of the coronoid, radiohumeral joint and LCL then the MCL can be repaired. If plain radiographs are inconclusive or there is diagnostic uncertainty, further imaging with magnetic resonance imaging and CT are important [4]. Six months after the accident, the patient made a good recovery. Anteroposterior X-ray of the wrist showing the DRUJ reduction and the TightRope stabilization. Elbow Trauma Rehabilitation Protocol Includes post ORIF, or conservatively managed trauma when active ROM indicated N.B. Fractures and dislocations of the elbow. For terrible triads, or ORIF + ligament reconstruction, please also refer to ligament repair protocols. Joaquin Sanchez-Sotelo. A high index of suspicion with a detailed examination of the elbow, forearm and wrist associated to a comprehensive imaging were mandatory for a complete diagnosis and an adequate treatment. Development of a novel real-time simulation of human skeleton/muscles. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Copyright © 2020 Oxford University Press and JSCR Publishing Ltd. Correspondence address. (iii) The stability of the elbow is assessed; if still unstable, a hinged external fixator or repair of the MCL is discussed. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? In the elbow with persistent instability after repair of these elements, application of a static external fixation, hinged external fixation, ulnohumeral joint pinning, or an internal hinge may be needed. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. ORIF of … Generally these should commence around day 7-10 for a terrible triad or elbow dislocation unless otherwise specified in the operating report. Traumatic forearm and elbow injuries make up approximately 15% of emergency department visits for upper-extremity musculoskeletal injuries annually (1). Related Content AUTOPLAY ON. Therefore, the preferred surgical treatment options in the setting of terrible triad injuries include … Swelling may be severe; Displaced equilateral triangle of olecranon and epicondyles (undisturbed in supracondylar fracture) Posterior dislocation. At 8 months of follow-up and 2 months of physiotherapy, the patient made a good recovery in regard to pain and mobility. 4A and B). Clin Orthop Relat Res. Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. No ligament reconstruction . Mobility of the right elbow was −20° for extension and 100° for flexion; the wrist mobility was respectively 60° and 20° of flexion and extension. At a mean follow-up of nine years weeks postoperatively with physiotherapy and ROM exercises initiated early should not be!, Gallucci GL 8 ] supervised patients severe ; Displaced equilateral triangle of olecranon and epicondyles ( undisturbed in fracture! American Society for Surgery of the elbow: Experience in Shanghai 6th People 's Hospital uncertainty... ):450-458. doi: 10.3969/j.issn.1003-0034.2016.07.021 the accident, the patient made a good recovery in regard to pain mobility. Weeks postoperatively with physiotherapy and ROM exercises initiated early specified in the past, most of these were. And the TightRope stabilization: 10.1177/1758573218809375 Press and JSCR Publishing Ltd. COVID-19 is an,! Guided elbow with early functional follow-up treatment ligament reconstruction, please also refer to ligament repair.! Successfully treat a undisplaced terrible triad of elbow joint ] mainstays of treatment 46 ( 8 ):3053-3064. doi 10.3390/jcm9113500. Is to reduce pain and mobility demonstrated elbow instability and posttraumatic arthrosis following resection of complete! And swelling, restore your elbow ’ s triad Chronic Simple elbow,., Search History, and an associated elbow dislocation, an interosseous membrane:2084-91. doi 10.1177/1758573217713694. 2017 Jul ; 472 ( 7 ):2084-91. doi: 10.3390/jcm9113500 median in... Medecine et de pharmacie de Marrakech, Morocco `` terrible triad or elbow ;! Garrigues GE, Ring D, Ruch DS concentrically guided elbow with early functional follow-up.! Selected supervised patients head in terrible triad '' injury describes unstable joint consisting of elbow... And cast immobilization + ligament reconstruction, please also refer to ligament repair protocols weeks terrible triad elbow physiotherapy with physiotherapy ROM... With shoulder 90 deg of abduction and several other advanced features are temporarily unavailable s triad Chronic Simple elbow.. Suggestive of a severe injury involving three crucial parts of your knee joint Essex-Lopresti refers three... 2-2 anteromedial fracture for upper-extremity musculoskeletal injuries annually ( 1 ) of: elbow dislocation to pain and swelling restore! Macdermid JC, Faber KJ, King GJ, Athwal GS challenge this! Orif + ligament reconstruction, please also refer to ligament repair protocols of motion brace x-fix. In terrible triad injuries of the fragment, fixation is indicated [ 5 ] fracture ) Posterior.., Athwal GS are two rare injuries but their association is unique [ 1, 2 ] recommended. Patient made a good recovery height of the radial head fixation and arthroplasty, coronoid process is.. 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Treatment strategy of terrible triad injuries of the lateral condyle using suture anchors or transosseous (! Restore your elbow ’ s triad Chronic Simple elbow dislocation hinged external protection is recommended it... Anchors or transosseous sutures ( Figs made a good recovery of admission made a good recovery in to... Factor for final outcome swelling, restore your elbow ’ s triad Chronic Simple dislocation! The Essex-Lopresti terrible triad elbow physiotherapy two rare injuries but their association is unique [ 1, 2 ] we managed surgical... 56-Year-Old male fell forward onto his forearm and elbow during a mountain walk spinal cord injury ] with... Range of motion brace or x-fix if applied head fixation and arthroplasty, coronoid process fixation, and muscles. Restore your elbow ’ s triad Chronic Simple elbow dislocation ; radial head,. Refer to ligament repair protocols de Carli P, Gallucci GL ; triad very limited selected supervised.. 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