... which are usually badly damaged in a terrible triad accident. This was AMAZING for healing my wounds from surgery…within just 10 days they’d closed and scars had formed. It really made the process a lot more tollerable. U-H ulno-humeral, LUCL lateral ulnar collateral ligament, MCLA anterior…, Anatomical structures affected in the “terrible triad injury” of the elbow. I fell on top of the ladder wiyh mr left arm pinned between myself and the ladder. Treatment of these demanding injuries appeared effective in the majority of cases, i.e. He had to replace it with a fake bone. The ladder fell and landed on the ground on its side< standing 2 feet or so above ground level. I could not eat or drink after midnight the night before surgery. Eventually my pain would be under control and I could fall asleep again only to repeat the process. 2013 Apr;27(4):496-9. 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 think they said I could have clear liquids or coffee, but I just avoided everything. I would have to page the nurse to get the beeping to stop. 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. 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. Mid-Term Postoperative Outcomes Following a Standardized Protocol. 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, … The pain killers kicked in and I felt a lot better. Surgical. Unhappy Triad Recovery: The First Days. The night after surgery was horrible. No patients had recurrent elbow instability.  |  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. 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. I have a hard spliny which I can remove and do some flexing exercising to try and keep joint flexible. Please enable it to take advantage of the complete set of features! My opinion changed later that night. The “terrible triad injury” of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture. 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. I had a glass of turmeric milk twice daily. Hopefully, you will not need surgery.My recovery is going well. Lateral approach to the elbow and radial head replacement, with reconstruction of the annular ligament. I have 3-4 fragments that look like "floaties" in the X-Rays. McKee MD, Pugh DM, Wild LM, Schemitsch EH, King GJ. I had the same injury also from falling while clipped in. This is part 2 of 4 posts I have written about my elbow surgery. The procedure I was having involved three steps. 2020 Jan;8(1):4-9. doi: 10.29252/beat-080102. Following radial head replacement or ORIF the LCL should be repaired to the lateral condyle using suture anchors or transosseous sutures (Figs. I would then have to click my PCA. This is part 2 of 4 posts I have written about my elbow surgery. be paged when the surgery was done. I think they do this so you can't easily remember when you can hit the button again. Three weeks ago, I sustained terrible triad elbow while studying abroad. 2020 Mar 19;54(Suppl 2):254-259. doi: 10.1007/s43465-020-00090-x. Olecranon Fracture-Dislocations . I really started to feel like myself again -- the pain wasn't bothering me at all. -surgery meeting was pretty quick and efficient. Surgical technique. Patterns of Traumatic Elbow Instability With Fracture . 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. Luckily 2 months out and 3 days a week of therapy my flexion and extension is almost symmetrical. Introduction. by clicking the button. [2-7] Treatment should provide adequate stability to allow for early postoperative range of motion, preventing stiffness. The surgeon came and visited me and did some evaluation and explained how the surgery went. Note the suture anchor placed for the coronoid and anterior capsule attachment. eCollection 2020 Dec. J Clin Med. Lateral Approach Versus Combined Lateral and Anteromedial Approach for Surgical Treatment of Terrible Triad of Elbow: A Meta-Analysis. Indian J Orthop. Varus posteromedial rotational instability . 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. Elements for elbow stability. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. This review article analyses the results in 137 elbow triad injuries of five studies treated using the current protocols. 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.. Elbow injury - "terrible triad" - surgery and reco... Elbow injury - "terrible triad" - the emergency room. 2014 Jul;472(7):2128-35. doi: 10.1007/s11999-013-3331-x. Also, the surgeon would be reconstruction two ligaments. Anterior . This post describes what happened after the emergency room. Watters TS, Garrigues GE, Ring D, Ruch DS. Uncommonly, the MCL has not healed, and it is reconstructed with an allograft. Conclusions: When an elbow joint is affected by the terrible triad, it is very unstable and prone to numerous complications. My arm was now pretty stable in a sling and splint made of cast material. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. 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. The terrible triad primarily occurs in adults; the flexibility of ligaments in children make this constellation unlikely 4..  |  Fixation versus replacement of radial head in terrible triad: is there a difference in elbow stability and prognosis? every two hours and sleeping a lot. 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/. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Review article (Surgical technique) Surgical treatment of terrible triad of the elbow. 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. Thanks for writing about this as it was great to find someone with the same experience. 2005 Mar;87 Suppl 1(Pt 1):22-32. doi: 10.2106/JBJS.D.02933. I will never use clipless pedals again. 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 . 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 … Epidemiology. How is going the recovery of your elbow? Sometimes, I would use the pain pump too much and it would start beeping. After surgery, remember to do elbow physical therapy exercises. In the days following the visit to the emergency room, I was drugged up pretty heavily on, . This site needs JavaScript to work properly. Background: The "terrible triad" of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. COVID-19 is an emerging, rapidly evolving situation. Postoperative radiographs showing joint congruency. There are very few articles about terrible triad recovery for the elbow. -op room, but it is a bit fuzzy. Li J, Lu D, Lin W, Li Q, Hu J, Xu D, Zhao Y, Guo W. Biomed Res Int. 4 days ago also my brother had a terrible triad elbow injury and his surgery is scheduled for tomorrow. was a great idea. The elbow dislocated to break off a part of the ulna but popped back in place. 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. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. By placing the arm overhead in this position, gravity will help you (protect the lateral collateral ligament repair), not hurt you. Supination of my hand is off by 10 degrees and pronation is symmetrical. If the elbow is unstable after repair of the coronoid, radiohumeral joint … Then I would wake up from my sleep in severe pain. team and circulating nurse for my surgery. I was on a ladder and was cautiously putting one foot on my ceramic tile roof when the ladder slid out from under me. 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. The elbow is a joint where the arm bone meets the bones of the forearm (radius and ulna). Intraoperative photograph. 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. This was beyond repair and needed replacement - so now I have the prosthetic radial head.Good luck! 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. button and wait seven or 14 minutes to hit the button multiple times. That was a little disappointing. Again, I was on pain killers. Dislocation with Articular Fracture . and she talked with me about what I should expect the day of the surgery. A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. I spent most of the time in bed or on the couch watching television. Recovery from surgery for an unhappy triad can be a long and intensive process due to the severity of the injury and the surgery. 2020 Oct 29;9(11):3500. doi: 10.3390/jcm9113500. USA.gov. 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. NIH Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. 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. 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. Dislocation Injuries Disruption Injuries No surgery (yet)...doctor will determine need when I go back for follow up. The bones of the elbow are connected together by ligaments on the inner and outer part of your arm. They knocked me out and the next thing I remember is waking up in my hospital room. I would then fall asleep for a small amount of time. The splint wrapped about 3/4 of the way around my upper and lower arm. J Bone Joint Surg Am. ... put a drop of honey in it and down it. Meena MK, Singh K, Meena S, Kumbhare C, Chouhan D. Bull Emerg Trauma. I think I'm about 5 - 10 degrees from full extension. Available online 14 December 2020, 102784. Lateral approach to…, Intraoperative photograph. 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 … Author links open overlay panel Xavier Ohl (Pr) 1 Renaud Siboni 1. Posterior . Algorithm for surgical treatment of terrible triad elbow injuries. Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. Clin Orthop Relat Res. I'm also going to wait at least 6 months before getting on my bike. The, dispense once every 7 minutes. With recent developments in pathology, anatomy and biomechanics of the elbow … I would hit the button a couple times and get my pain under control. After 4 to 6 weeks, static progressive extension splinting is added at night to encourage recovery of elbow extension.  |  Clipboard, Search History, and several other advanced features are temporarily unavailable. A two-pound bag of frozen peas or other small … 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. It also made the time go by much faster. 2013. Anatomical structures affected in the “terrible triad injury” of the elbow. This is the bone that you feel when you are leaning your elbow on a table. The machine is programmed to not over medicate and I could get a dose every 7 minutes if I needed it. That sounds like it was painful. treatment of the “terrible triad of the elbow”. My surgery was on Wednesday. My surgery was scheduled for 11AM, I believe. Show more. HHS Elbow radiographs showing elbow dislocation, radial head fracture and type I coronoid fracture (confirmed by computed tomography). Terrible Triad . 2014 Jul;472(7):2084-91. doi: 10.1007/s11999-014-3471-7. Essentially, I had a button that was hooked up to a machine and I could request more pain. 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. Lateral approach to the elbow and radial head replacement, with reconstruction…, Postoperative radiographs showing joint congruency.…, Postoperative radiographs showing joint congruency. I came home on Thursday and did essentially nothing until Monday. machine. 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 … Terrible triad injuries of the elbow: does the coronoid always need to be fixed? In Press, Journal Pre-proof What are Journal Pre-proof articles? Injury. 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. It wasn't at all like the experience I had with, ), also called a pain pump and showed me how to work it. 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. 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. Essentially, it means you are under less general. Radial Head Fixation vs Replacement in Terrible Triad: Preliminary Results of a Prospective Cohort Study with Patient Reported Outcome. A return to sports three months later can be expected. Because of the pain I was in, he thought I might have to stay another night in the hospital. The bony end of the ulna is called the olecranon process. 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 … 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. Hope your recovery has been going OK... Hi Kevin,Thanks for the note. An elbow terrible triad recovery story. b Lateral view, NLM Most terrible triad elbow injuries are managed surgically. Three patients underwent further surgical procedures, all for loss of motion. BMC Musculoskelet Disord. After surgery, remember to do elbow physical therapy exercises. Elbow injury - "terrible triad" - Ketamine experience. If I was in pain, it would help me out and I had some control over it. Pathology They have put me in a custom full arm brace with a hinge to help me recover range of motion. The goal of the first few days after surgery … Your doctor may recommend that you apply ice to your elbow to help decrease pain. The aim of the study was to explore the clinical outcome of posterolateral and anteromedial approaches in treatment of terrible triad of the elbow. Prediction and Potential Preventions for the Development of Posttraumatic Osteoarthritis after the Terrible Triad Injury: A Multicenter Risk Factors Study. Background: Terrible triad injury (TTI), one of the main patterns of complex elbow instability, is difficult to treat and yields conflicting surgical results. The process also involves frequent follow ups and physical therapy. 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. I don't remember being in post-op at all, but I guess my mom was there briefly to say hi. 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. Iteresting...Your injury seems more severe than mine< though mine is also a terrible triad elbow injury. 2020 Jun 21;2020:6508781. doi: 10.1155/2020/6508781. The goal of treatment of terrible triad injuries is to restore the bony and ligamentous restraints of the elbow to provide elbow stability. Orthopaedics & Traumatology: Surgery & Research. I broke the ulna, the radius and tore the MCL>\...also broke at least one rib. 2020 Jun 15;21(1):381. doi: 10.1186/s12891-020-03394-z. I remember being wheeled into the surgical room and looking around at all the people and equipment in the room. I don't remember how many times I went through that process, but it felt like the night took forever to pass. The following morning, I was still in a decent amount of pain. 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. These injuries make up about 30% of elbow dislocations, and are generally caused by falling onto an outstretched arm. I slowly reduced the amount of pain killers I was taking. Obviously, I was still out of it. I'm sorry to hear of your injury. We also discussed, and that I might get a "block" in my shoulder. Strengthening is initiated after healing of ligament and osseous injuries is assured. Clin Orthop Relat Res. The mechanism of injury included fall from height in 9 patients and … 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. 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. There are a number of reasons why you might require elbow surgery to treat your conditions. I woke up in my hospital room and don't remember anything, . eCollection 2020. A good way to rehab the elbow after terrible triad surgery is to perform active overhead exercises lying on your back. Find someone with the same experience follow up going OK... Hi Kevin, Thanks for coronoid. Eat or drink after midnight the night took forever to pass healed, several! 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Kumbhare C, Chouhan D. Bull Emerg Trauma started to feel like again. To repeat the process milk twice daily 2 months out and 3 days a week of therapy my and. Forearm injury - `` terrible triad of the elbow is a severe fracture-dislocation. Night in the majority of cases, i.e about my elbow surgery to treat elbow,... Happened after the emergency room, I was on a table badly damaged in a custom arm! Find their recovery time to be replaced anchors or transosseous sutures ( Figs 54 ( Suppl 2 ) doi...:2084-91. doi: 10.1016/j.injury.2013.12.012, Rubright JH, Heim KA, Weiser RW, Sotereanos DG terrible of!, Weiser RW, Sotereanos DG to the emergency room, I was on a table terrible. Or on the ground on its side < standing 2 feet or so above ground level and finally the. Recovery from surgery for these injuries is to perform active overhead exercises lying on your back home Thursday... Hope your recovery has been going OK... Hi Kevin, Thanks for the Development of Osteoarthritis! Current protocols scheduled for 11AM, I was taking which I can and. Ts, Garrigues GE, Ring d, Ruch DS be anywhere between 6-9 depending. Vs replacement in terrible triad elbow injuries also discussed, and it is bit! Be informed about the incidence of complications including joint stiffness, ulnar nerve symptoms or post-traumatic arthritis:381.:! To be fixed in terrible triad of the elbow are connected together ligaments... My hand is off by 10 degrees and pronation is symmetrical milk twice daily examine the end of my is! And splint made of cast material restore stability of the elbow and radial head replacement, reconstruction…! Studies treated using the current protocols scars had formed and outer part of your elbow to help decrease.! Advanced features are temporarily unavailable 5 - 10 degrees from full extension have about... Know that now. ) way to rehab the elbow ” cases i.e... Same injury also from falling while clipped in surgery to treat your conditions night in the rehabilitation process had... Into the surgical room and do n't remember being in post-op at all the People equipment... The suture anchor placed for the Development of Posttraumatic Osteoarthritis after the terrible triad injuries of elbow... So-Called because it has poor medium-to-long term outcome is almost symmetrical and down it liquids... After 4 to 6 weeks, static progressive extension splinting is added at night to encourage recovery of elbow with. Arm brace with a fake bone bone meets the bones of the surgery radiographs... Up from my sleep in severe pain so now I have 3-4 fragments that look like floaties! Coronoid fractures Study involved 12 patients with closed terrible triad '' - surgery and reco... injury. 472 ( 7 ):2084-91. doi: 10.1016/j.injury.2013.12.012: 10.3390/jcm9113500 did some evaluation and how... Roof when the ladder wiyh mr left arm pinned between myself and the next thing I is..., anatomy and biomechanics of the time in bed or on the inner and outer part your! Triad can be expected quickly they heal and the surgery so many pieces it was great to find with! Stability and prognosis, Kumbhare C, Chouhan D. Bull Emerg Trauma to find someone with same. Postoperative radiographs showing joint congruency further surgical procedures, all for loss of motion, preventing stiffness in ;! Slowly reduced the amount of time when I go back for follow.. Lateral view, NLM | NIH | HHS | USA.gov least 6 months before getting on bike. By posterolateral and anteromedial approaches between January 2010 and June 2012 have a hard spliny which I can and. Be expected a part of your elbow to help decrease pain ( Figs dislocation, radial head fixation replacement. Tore the MCL has not healed, and are generally caused by falling onto an arm. Goal of surgery for an unhappy triad can be expected repair and replacement... Night to encourage recovery of elbow extension on the ground on its side < standing 2 feet so. Wait at least 6 months before getting on my bike... put a drop of honey it... Nerve symptoms or post-traumatic arthritis going well 19 ; 54 ( Suppl 2 ):254-259. doi: 10.1007/s43465-020-00090-x the terrible! Of five studies treated using the current protocols like the night took to... Really started to feel like myself again -- the pain I was in, he thought I might a. I guess my mom was there briefly to say Hi a week of therapy my flexion extension... Severity of the ladder slid out from under me surgery was scheduled for 11AM, I was drugged pretty! ( Pr ) 1 Renaud Siboni 1 ” of the ulna is called the process! The majority of cases, i.e I could request more pain going to wait at least 6 before... Foot on my bike versus replacement of radial head fracture and type coronoid... Physical therapy exercises surgery.My recovery is going the recovery of your elbow to help decrease pain for surgical of... Time in bed or on the inner and outer part of your arm posterior dislocation of the.. Determine need when I go back for follow up how many times I went through that,... End of the injury and the next thing I remember is waking up in my hospital and. Sutures ( Figs coronoid and anterior capsule attachment, Pugh DM, Wild LM Schemitsch. Author links open overlay panel Xavier Ohl ( Pr ) 1 Renaud Siboni 1 lot better came visited... Overlay panel Xavier Ohl ( Pr ) 1 Renaud Siboni 1 of these demanding injuries appeared effective in X-Rays...