gms | German Medical Science

Objectives: The “terrible triad”' of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. In order to determine optimal treatment method, several studies focused on the surgical options within the framework of the protocol. Repair of the medial collateral ligament (MCL) is also a notable option for the protocol; it is regarded as the last step only in the case with residual instability despite the management of radial head, coronoid process and lateral collateral ligament (LCL).To date, it is still controversial whether surgical approach to the MCL should be performed or not. Therefore, the purpose of this study was to investigate the (1) range of motion; (2) clinical scores using the Disabilities of the Arm, Shoulder and Hand (DASH) and the Broberg-Morrey questionnaires; and (3) rate of arthritic changes, heterotopic ossification (HO), or elbow instability postoperatively in patients whose terrible triad injuries of the elbow included MCL injuries that were treated without repairmen or reconstruction.

Methods: Thirty-four patients who underwent surgery with a minimum of 24-month follow-up (mean, 29.2 months) were reviewed. Based on the systematic treatment protocol, radial head fracture, lateral collateral ligament, and coracoid fracture were treated. Subsequently, torn MCL was repaired in 14 patients, whereas in the remaining 20 patients, the MCL was treated by using the adjustable brace without surgical fixation. Range of motion, clinical scores using the Disabilities of the Arm, Shoulder and Hand (DASH) and the Broberg-Morrey questionnaires, and rate of arthritic changes, heterotopic ossification (HO), or elbow instability postoperatively were assessed periodically.

Results: At final follow-up, no significant differences were found in range of elbow motion, clinical scores of Disabilities of the Arm, Shoulder and Hand (DASH) and the Broberg-Morrey questionnaires, and elbow instability between these two groups with and without MCL repair; except the pronation and supination which had superior range in repair group. In contrast, radiologic findings such as the rate of arthritic changes, heterotopic ossification were seen more frequently in patients without MCL repair than those with surgical repair.

Conclusion: Our results indicate the effect of MCL repair on elbow motion and function might be small, whereas osteoarthritic changes and heterotopic ossification occurred more frequently in elbows without MCL repair.