Surgical Outcomes of Terrible Triad Injuries of the Elbow in a Resource-Limited Setting: A Consecutive Case Series.
- 1Hospital for Traumatology and Orthopaedics, Ho Chi Minh City, Vietnam.
- 2University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Abstract
Purpose
To evaluate surgical outcomes of acute terrible triad injuries of the elbow treated without radial head prostheses or hinged external fixation and to identify factors associated with recovery in a resource-limited setting.Methods
We retrospectively reviewed 30 of 151 eligible adults treated surgically between January 2021 and June 2024 at a tertiary trauma center in Vietnam. Mean follow-up was 13.9 ± 8.9 months. Outcomes included Mayo Elbow Performance Score (MEPS), Subjective Elbow Value, range of motion, radiographic findings, instability, and complications. Radial head fixation was performed in 66.7%, excision in 13.3%, coronoid fixation in 80%, lateral collateral ligament repair in 73.3%, and medial collateral ligament (MCL) repair in 33.3%.Results
Mean MEPS was 81.2 ± 13.9, with 76.7% achieving good-to-excellent outcomes. Overall instability occurred in 40%, while concentric reduction was maintained in 73.3% and subluxation occurred in 26.7%. Radial head nonunion occurred in 15% of fixation cases. Radial head excision without MCL repair was associated with increased valgus carrying angle, while supervised physiotherapy was associated with a smaller extension deficit. No deep infections or reoperations were recorded. However, 3 of 18 patients treated with trans-humeral K-wires (16.7%) sustained iatrogenic olecranon fractures. Radiographic arthritis occurred in 50%.Conclusions
Acceptable short-term functional outcomes can be achieved despite limited implant availability, but instability and radiographic complications remain substantial. Given the 19.9% follow-up rate, findings should be interpreted cautiously because of potential selection bias. Radial head preservation and MCL repair when excision is unavoidable are recommended, while trans-humeral K-wire stabilization should be used selectively.Type of study/level of evidence
Therapeutic IV.
Related
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BibTeX
@article{pham2026surgical,
title = {{Surgical Outcomes of Terrible Triad Injuries of the Elbow in a Resource-Limited Setting: A Consecutive Case Series.}},
author = {Hoa Thi My Pham and Hung Phuoc Do and Thy Gia Anh Le},
journal = {Journal of hand surgery global online},
year = {2026},
month = oct,
doi = {10.1016/j.jhsg.2026.101166},
url = {https://europepmc.org/article/MED/42898830},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Surgical Outcomes of Terrible Triad Injuries of the Elbow in a Resource-Limited Setting: A Consecutive Case Series.
AU - Hoa Thi My Pham
AU - Hung Phuoc Do
AU - Thy Gia Anh Le
PY - 2026
DA - 2026/10/12
JO - Journal of hand surgery global online
DO - 10.1016/j.jhsg.2026.101166
UR - https://europepmc.org/article/MED/42898830
AB - Purpose To evaluate surgical outcomes of acute terrible triad injuries of the elbow treated without radial head prostheses or hinged external fixation and to identify factors associated with recovery in a resource-limited setting.Methods We retrospectively reviewed 30 of 151 eligible adults treated surgically between January 2021 and June 2024 at a tertiary trauma center in Vietnam. Mean follow-up was 13.9 ± 8.9 months. Outcomes included Mayo Elbow Performance Score (MEPS), Subjective Elbow Value, range of motion, radiographic findings, instability, and complications. Radial head fixation was performed in 66.7%, excision in 13.3%, coronoid fixation in 80%, lateral collateral ligament repair in 73.3%, and medial collateral ligament (MCL) repair in 33.3%.Results Mean MEPS was 81.2 ± 13.9, with 76.7% achieving good-to-excellent outcomes. Overall instability occurred in 40%, while concentric reduction was maintained in 73.3% and subluxation occurred in 26.7%. Radial head nonunion occurred in 15% of fixation cases. Radial head excision without MCL repair was associated with increased valgus carrying angle, while supervised physiotherapy was associated with a smaller extension deficit. No deep infections or reoperations were recorded. However, 3 of 18 patients treated with trans-humeral K-wires (16.7%) sustained iatrogenic olecranon fractures. Radiographic arthritis occurred in 50%.Conclusions Acceptable short-term functional outcomes can be achieved despite limited implant availability, but instability and radiographic complications remain substantial. Given the 19.9% follow-up rate, findings should be interpreted cautiously because of potential selection bias. Radial head preservation and MCL repair when excision is unavoidable are recommended, while trans-humeral K-wire stabilization should be used selectively.Type of study/level of evidence Therapeutic IV.
SN - 2589-5141
ER -