I slowly reduced the amount of pain killers I was taking. It also made the time go by much faster. This review article analyses the results in 137 elbow triad injuries of five studies treated using the current protocols. BMC Musculoskelet Disord. The elbow is a joint where the arm bone meets the bones of the forearm (radius and ulna). Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. Pathology I remember being wheeled into the surgical room and looking around at all the people and equipment in the room. And finally, the surgeon would examine the end of my radial bone and determine if it needed to be replaced. [2-7] Treatment should provide adequate stability to allow for early postoperative range of motion, preventing stiffness. The mechanism of injury included fall from height in 9 patients and … I have a hard spliny which I can remove and do some flexing exercising to try and keep joint flexible. The night after surgery was horrible. Introduction. This is part 2 of 4 posts I have written about my elbow surgery. treatment of the “terrible triad of the elbow”. I don't remember how many times I went through that process, but it felt like the night took forever to pass. The process also involves frequent follow ups and physical therapy. My arm was now pretty stable in a sling and splint made of cast material. eCollection 2020 Dec. J Clin Med. Dislocation Injuries Disruption Injuries A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. I fell on top of the ladder wiyh mr left arm pinned between myself and the ladder. I would hit the button a couple times and get my pain under control. 2005 Mar;87 Suppl 1(Pt 1):22-32. doi: 10.2106/JBJS.D.02933. I'm also going to wait at least 6 months before getting on my bike. Clin Orthop Relat Res. Note the suture anchor placed for the coronoid and anterior capsule attachment. lated terrible triad injury, when re-sidual instability was present after LCL repair and radial head repair or arthroplasty, repair of the MCL was more effective than fixation of small coronoid fractures in restoring elbow stability.15 In clinical series of terrible triad injuries, most … A two-pound bag of frozen peas or other small … U-H ulno-humeral, LUCL lateral ulnar collateral ligament, MCLA anterior…, Anatomical structures affected in the “terrible triad injury” of the elbow. With operative treatment, the surgeon should attempt to perform internal fixation of the coronoid fracture, to regain normal radiocapitellar contact (either by preserving the radial head with open reduction and internal fixation (ORIF) or by replacing it with a prosthesis), and to repair … Methods: This study included 16 patients (average age: 34 years) who underwent surgery following a diagnosis of terrible triad injury of the elbow between 1996 and 2007. Clipboard, Search History, and several other advanced features are temporarily unavailable. Methods: Eight patients identified with “terrible triad” injury patterns, including posterior elbow dislocation, radial head fracture and coronoid fracture, were available for a minimum of 11 months follow-up. Key words: elbow; radius fractures INTRODUCTION The ‘terrible triad’ of the elbow … The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. Surgical technique. However, advances in the knowledge of elbow kinematics combined with improved implants and surgical techniques during the past few years have led to the development of standard surgical protocols. The procedure I was having involved three steps. These injuries make up about 30% of elbow dislocations, and are generally caused by falling onto an outstretched arm. The “terrible triad injury” of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture. (I bet your glad you know that now.). McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ. Injury. Postoperative radiographs showing joint congruency. button and wait seven or 14 minutes to hit the button multiple times. Uncommonly, the MCL has not healed, and it is reconstructed with an allograft. I would then have to click my PCA. In the days following the visit to the emergency room, I was drugged up pretty heavily on, . 4 and 5). Intraoperative photograph. The surgeon was going to be doing an "open reduction and internal fixation" which from what I understand means that he would be opening my arm to put the elbow back in socket. Eventually my pain would be under control and I could fall asleep again only to repeat the process. Anterior . a Anteroposterior view. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Conclusions: When an elbow joint is affected by the terrible triad, it is very unstable and prone to numerous complications. A good way to rehab the elbow after terrible triad surgery is to perform active overhead exercises lying on your back. I spent most of the time in bed or on the couch watching television. Strengthening is initiated after healing of ligament and osseous injuries is assured. The, dispense once every 7 minutes. Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome. Li J, Lu D, Lin W, Li Q, Hu J, Xu D, Zhao Y, Guo W. Biomed Res Int. Hope your recovery has been going OK... Hi Kevin,Thanks for the note. Orthopaedics & Traumatology: Surgery & Research. Again, I was on pain killers. Background: The "terrible triad" of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. -surgery meeting was pretty quick and efficient. Iteresting...Your injury seems more severe than mine< though mine is also a terrible triad elbow injury. With recent developments in pathology, anatomy and biomechanics of the elbow … I think they do this so you can't easily remember when you can hit the button again.  |  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. USA.gov. -op room, but it is a bit fuzzy. J Bone Joint Surg Am. every two hours and sleeping a lot. Elbow injury - "terrible triad" - surgery and reco... Elbow injury - "terrible triad" - the emergency room. I could not eat or drink after midnight the night before surgery. Elbow Surgery Recovery Video; Elbow Elevation Technique Video; ... Elbow Surgery Information Sheet; Download Dr. Myeroff’s Surgery Instructions & Expectations - Elbow Surgery Information Sheet; Physical Therapy Intro Video ... Download Dr Myeroff's Post-Op Protocol for Terrible Triad Fracture Dislocation – ORIF; Related Topics. This was AMAZING for healing my wounds from surgery…within just 10 days they’d closed and scars had formed. Lateral Approach Versus Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis. 2020 Jun 15;21(1):381. doi: 10.1186/s12891-020-03394-z. 2020 Jan;8(1):4-9. doi: 10.29252/beat-080102. Recovery from surgery for an unhappy triad can be a long and intensive process due to the severity of the injury and the surgery. Three weeks ago, I sustained terrible triad elbow while studying abroad. I broke the ulna, the radius and tore the MCL>\...also broke at least one rib. I haven't had a lot of experience with surgery in other hospitals, but I was very impressed by the efficiency and thoughtfulness that went into the process. The goal of treatment of terrible triad injuries is to restore the bony and ligamentous restraints of the elbow to provide elbow stability.  |  The study involved 12 patients with closed terrible triad of the elbow treated by posterolateral and anteromedial approaches between January 2010 and June 2012. Because of the pain I was in, he thought I might have to stay another night in the hospital. An elbow terrible triad recovery story. I don't remember being in post-op at all, but I guess my mom was there briefly to say hi. It really made the process a lot more tollerable. You can read them all here: In my last post I described how I broke my arm/elbow and the experience of the emergency room. The terrible triad of the elbow is a severe elbow fracture-dislocation pattern and is so-called because it has poor medium-to-long term outcome.. I was on a ladder and was cautiously putting one foot on my ceramic tile roof when the ladder slid out from under me. Overhead active motion exercises for terrible triad … The splint wrapped about 3/4 of the way around my upper and lower arm. My surgery was on Wednesday. Surgical. We analyzed prospectively a series of patient affected by TTI and treated according to the current diagnostic and surgical protocols to investigate whether their application allow to obtain more predictable outcomes. Posterior . Elements for elbow stability. I had the same injury also from falling while clipped in. Sometimes, I would use the pain pump too much and it would start beeping. It turned out that the end of my raidal bone was broken into so many pieces it was beyond repair. Patterns of Traumatic Elbow Instability With Fracture . I still have to stretch it every day.For me, I think the biggest problem was that I shattered my radial head into little bits. Hi,How is going the recovery of your elbow?4 days ago also my brother had a terrible triad elbow injury and his surgery is scheduled for tomorrow.It should be very useful and important for us if you could share your experience and recovery stages Really thanks in advance Felice. Supination of my hand is off by 10 degrees and pronation is symmetrical. 2020 Mar 19;54(Suppl 2):254-259. doi: 10.1007/s43465-020-00090-x. 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 … Treatment strategy of terrible triad of the elbow: experience in Shanghai 6th People's Hospital. The bones of the elbow are connected together by ligaments on the inner and outer part of your arm. We also discussed, and that I might get a "block" in my shoulder. Hopefully, you will not need surgery.My recovery is going well. I was also taking some over the counter medication to counteract some of the side effects of the, is a diuretic and can cause severe constipation. I had a glass of turmeric milk twice daily. recovery of range of motion than those reported in other studies, the terrible triad of the elbow can lead to joint instability, osteoarthritis, arthrosis, and joint stiffness, and may resort to total elbow arthroplasty in some cases. The terrible triad primarily occurs in adults; the flexibility of ligaments in children make this constellation unlikely 4.. Essentially, it means you are under less general. Repairing the meniscus or reconstructing the MCL does not lead to any change in the rehabilitation process. This site needs JavaScript to work properly. ... put a drop of honey in it and down it. Most terrible triad elbow injuries are managed surgically. Dislocation of the elbow associated with radial head and coronoid fracture, the so-called "terrible triad" of the elbow, is challenging to treat and has a history of complicated outcomes. The combination of elbow dislocation with both radial head and coronoid process fracture is notoriously challenging to treat and, as such, has been termed “terrible triad” injury of the elbow (TTIE) .This type of elbow injury is typically due to low or high energy falls onto an outstretched hand, which results in valgus and axial compression of the supinated forearm . They have put me in a custom full arm brace with a hinge to help me recover range of motion. The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow.  |  There are very few articles about terrible triad recovery for the elbow. ... which are usually badly damaged in a terrible triad accident. The elbow must be “cold” — no active inflammation — which usually means waiting 6 months to 9 months, otherwise the rebound inflammation will disconcert any results achieved at surgery, … 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. 2020 Oct 29;9(11):3500. doi: 10.3390/jcm9113500. My elbow was about 90 degrees. No patients had recurrent elbow instability. eCollection 2020. Nevertheless, the patient should be informed about the incidence of complications including joint stiffness, ulnar nerve symptoms or post-traumatic arthritis. Please enable it to take advantage of the complete set of features! UCL ulnar…, Elbow radiographs showing elbow dislocation,…, Elbow radiographs showing elbow dislocation, radial head fracture and type I coronoid fracture…, Computed tomography showing a type II (Regan-Morrey) coronoid fracture, Intraoperative photograph. Available online 14 December 2020, 102784. The ladder fell and landed on the ground on its side< standing 2 feet or so above ground level. Essentially, I had a button that was hooked up to a machine and I could request more pain. I came home on Thursday and did essentially nothing until Monday. We treated twenty-five patients with terrible triad injury of the elbow from July 1, 2017, to June 30, 2020, and performed post hoc analysis. Watters TS, Garrigues GE, Ring D, Ruch DS. I think they said I could have clear liquids or coffee, but I just avoided everything. After 4 to 6 weeks, static progressive extension splinting is added at night to encourage recovery of elbow extension. Anatomical structures affected in the “terrible triad injury” of the elbow. Algorithm for surgical treatment of terrible triad elbow injuries. 2020 Jun 21;2020:6508781. doi: 10.1155/2020/6508781. 4 days ago also my brother had a terrible triad elbow injury and his surgery is scheduled for tomorrow. From what I understand, it is a numbing agent (maybe, , I don't remember) that is injected directly into the nerve that goes to your arm. Three patients underwent further surgical procedures, all for loss of motion. This post describes what happened after the emergency room. If I moved my arm away from my body it would hurt quite a bit, but as long as I didn't move it too much it felt okay. The bony end of the ulna is called the olecranon process. After surgery, remember to do elbow physical therapy exercises. be paged when the surgery was done. I really started to feel like myself again -- the pain wasn't bothering me at all. Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis? Does the Coronoid Always Need to Be Fixed in Terrible Triad Injuries of the Elbow? The elbow dislocated to break off a part of the ulna but popped back in place. Prediction and Potential Preventions for the Development of Posttraumatic Osteoarthritis after the Terrible Triad Injury: A Multicenter Risk Factors Study. Terrible Triad . A return to sports three months later can be expected. Olecranon Fracture-Dislocations . Your doctor may recommend that you apply ice to your elbow to help decrease pain. Most patients find their recovery time to be anywhere between 6-9 months depending on how quickly they heal and the extent of their injuries. Epub 2014 Jan 10. The authors concluded that a systematic approach to the fixation of "terrible triad" elbow fracture dislocations can provide predictable elbow stability and functional range of … National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. OBJECTIVE: The aim of this study was to evaluate the effect of surgical repair of the medial collateral ligament and ulnar nerve release in cases of terrible triad injuries of the elbow. Luckily 2 months out and 3 days a week of therapy my flexion and extension is almost symmetrical. Epidemiology. If I was in pain, it would help me out and I had some control over it. Background: Terrible triad injury (TTI), one of the main patterns of complex elbow instability, is difficult to treat and yields conflicting surgical results. team and circulating nurse for my surgery. Obviously, I was still out of it. You may want to place a pillow behind your elbow when seated or lying down to keep the surgery area forward to help decrease pain. Author links open overlay panel Xavier Ohl (Pr) 1 Renaud Siboni 1. My opinion changed later that night. Treatment of these demanding injuries appeared effective in the majority of cases, i.e. I should write a follow up, now that it has been a couple months since my injury.I'm probably not going to be able to fully extend my elbow, but I'm pretty close. [Progress in treatment of terrible triad of elbow]. I woke up in my hospital room and don't remember anything, . The machine is programmed to not over medicate and I could get a dose every 7 minutes if I needed it. I have 3-4 fragments that look like "floaties" in the X-Rays. On Monday I was able to do some work (I work from home) and it made me feel much better to be doing something normal. Here is what happened all night long. Dislocation of the elbow associated with radial head and coronoid fracture, the so-called "terrible triad" of the elbow, is challenging to treat and has a history of complicated outcomes. HHS After surgery, remember to do elbow physical therapy exercises. I think I'm about 5 - 10 degrees from full extension. Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. NIH I would then fall asleep for a small amount of time. machine. Then I would wake up from my sleep in severe pain. This is the bone that you feel when you are leaning your elbow on a table. Also, the surgeon would be reconstruction two ligaments. How is going the recovery of your elbow? In Press, Journal Pre-proof What are Journal Pre-proof articles? Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. 2013. No surgery (yet)...doctor will determine need when I go back for follow up. That sounds like it was painful. It wasn't at all like the experience I had with, ), also called a pain pump and showed me how to work it. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Jul;472(7):2084-91. doi: 10.1007/s11999-014-3471-7. Lateral approach to the elbow and radial head replacement, with reconstruction…, Postoperative radiographs showing joint congruency.…, Postoperative radiographs showing joint congruency. This was beyond repair and needed replacement - so now I have the prosthetic radial head.Good luck! That was a little disappointing. See this image and copyright information in PMC. I would have to page the nurse to get the beeping to stop. terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation. They knocked me out and the next thing I remember is waking up in my hospital room. The surgeon came and visited me and did some evaluation and explained how the surgery went. The objective was to analyze the long-term clinical outcome of terrible triad injury of the elbow following surgical intervention with a single lateral approach. Thanks for writing about this as it was great to find someone with the same experience. This is part 2 of 4 posts I have written about my elbow surgery. b Lateral view, NLM These include fixation of the coronoid fracture, repair or replacement the radial head, and repair of the lateral ligament complex, reserving medial collateral ligament repair and application of hinged external fixation for patients with residual instability. 2014 Jun;45(6):942-8. doi: 10.1016/j.injury.2013.12.012. Lateral approach to…, Intraoperative photograph. If the elbow is unstable after repair of the coronoid, radiohumeral joint … 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/. Mid-Term Postoperative Outcomes Following a Standardized Protocol. The pain killers kicked in and I felt a lot better. There are a number of reasons why you might require elbow surgery to treat your conditions. Dislocation with Articular Fracture . 2014 Jul;472(7):2128-35. doi: 10.1007/s11999-013-3331-x. However, advances in the knowledge of elbow kinematics combined with improved implants and surgical techniques during the past few years have led to the development of standard surgical protocols. Clin Orthop Relat Res. My surgery was scheduled for 11AM, I believe. He had to replace it with a fake bone. Dislocation + radial head fracture . Elbow injury - "terrible triad" - Ketamine experience. Elbow radiographs showing elbow dislocation, radial head fracture and type I coronoid fracture (confirmed by computed tomography). was a great idea. I'm sorry to hear of your injury. 2013 Apr;27(4):496-9. with an average of 31 months of follow-up, overall flexion arc was 111.4°, averaged flexion was 132.5° with forearm rotation of 135.5°, Mayo elbow performance score was 85.6 points, and Broberg-Morrey score was 85 points. Meena MK, Singh K, Meena S, Kumbhare C, Chouhan D. Bull Emerg Trauma. by clicking the button. Varus posteromedial rotational instability . The goal of the first few days after surgery … Review article (Surgical technique) Surgical treatment of terrible triad of the elbow. Show more. The following morning, I was still in a decent amount of pain. and she talked with me about what I should expect the day of the surgery. Unhappy Triad Recovery: The First Days. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. The serious full-length forearm injury - a case report and literature review. Lateral approach to the elbow and radial head replacement, with reconstruction of the annular ligament. Most painful part of this has been the ribs..a cough is excrutiating> Im only a week out from injury so I'm hopeful I heal and dont requie surgery. By placing the arm overhead in this position, gravity will help you (protect the lateral collateral ligament repair), not hurt you. Indian J Orthop. COVID-19 is an emerging, rapidly evolving situation. I will never use clipless pedals again. Repaired to the emergency room... also broke at least one rib brother had a glass turmeric... 2 ):254-259. doi: 10.1186/s12891-020-03394-z supination of my raidal bone was broken into so pieces... Explained how the surgery ceramic tile roof when the ladder fell and landed on inner... Did essentially nothing until Monday anything, ( 1 ):381. doi: 10.3390/jcm9113500 Multicenter Risk Factors Study it... And the surgery went could request more pain terrible triad elbow surgery recovery, Search History, and that might... Been going OK... 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Is programmed to not over medicate and I could have clear liquids or coffee, I! Is almost symmetrical triad surgery is scheduled for tomorrow make up about 30 % of elbow dislocations, and other! Complications including joint stiffness, ulnar nerve symptoms or post-traumatic arthritis Bull Emerg Trauma vs in. Suture anchor placed for the note injuries appeared effective in the “ terrible triad: Preliminary results of a Cohort... Use the pain I was still in a custom full arm brace with a fake bone fractures!