Functional and patient-reported outcomes of terrible triad elbow fracture-dislocations

Abstract

Background: The elbow ranks second only to the shoulder as the most commonly dislocated large joint in the human body. Terrible triad elbow injuries, or simply terrible triad (TT), involve an elbow dislocation coupled with a radial head and coronoid fracture. This study aimed to assess functional and patient-reported outcomes for surgically managed TT patients.

Methods: An ambidirectional observational study included all adults who underwent surgical treatment for TT over a six-year period.  Demographic data, elbow range of motion (ROM), and QuickDASH scores were collected. Elbow ROM data was used in a preferential order of a participation goniometer measurement followed by a photographic measurement and, lastly, recorded values within the patient’s file.

Results: Of the 49 eligible patients (mean age 37.5 ± 12.3 years), 39 patients followed up postoperatively at a median of 18.0 (2.0–34.3) months. Thirty-six of the 39 patients followed up postoperatively and had relevant data pertaining to elbow ROM. Of these, 17 were successfully recruited to participate. The mean flexion and extension endpoints were 118.7° ± 19.4° and 39.9° ± 19.3° respectively, while mean flexion-extension arc (FEA) was 77.4° ± 28.5° (n = 36). Pronation and supination had mean endpoints of 58.4° ± 26.4° (n = 32) and 54.9° ± 32.5° (n = 30) respectively, with mean prosupination arc (PSA) at 111.2° ± 52.3° (n = 30). Median (interquartile range) QuickDASH score among participants was 31.8 (9.1–47.7), with seven participants scoring < 25 (9.1 [8.0–10.2]) and eight participants between 25 and 50 (40.9 [35.2–48.3]). Functional flexionextension ROM, accepted as 130° flexion and 30° extension with a FEA of 100°, was not met, but prosupination functional ROM (50° prosupination and 100° PSA) was retained.

Conclusion: Discrepancies that exist between the measured ROM and the subjective patient outcomes suggest that further  investigation is needed to understand the clinical impact on patient experience and functionality.

Level of evidence: 3