Open Reduction and Internal Fixation Versus Resection of the Radial Head to Treat Terrible Triad Injury of the Elbow: What if Radial Head Replacement is not Possible?

Background: Terrible triad of elbow injury (TTI) has great potential for joint instability with a relatively poor prognosis. Different surgical methods have been introduced for radial head fractures. In this study, we aimed to evaluate the results of treatment of radial head fractures with open reduction and internal fixation (ORIF) and resection in TTI patients when radius head replacement was not attainable.

Materials And Methods: In this retrospective study, 48 patients with TTI who underwent radial head fracture surgery with ORIF (n = 33) or resection (n = 15) were included. During follow-up, patients were evaluated for elbow range of motion (ROM), pain score, complications, need for reoperation, and Mayo Elbow Performance Score (MEPS). ORIF and resection groups were followed for 49.47 ± 28.58 and 52.79 ± 23.57 months, respectively.

Results: Compared to the resection group, the ORIF group had significantly better ROM in extension and pronation and lower supination, although, when compared with a subgroup of mason type III fractures, the resection group had substantially better ROM in extension, pronation, and supination and better MEPS. The resection group had lower rates of pain score, instability, arthritis, heterotopic ossification, and need for reoperation compared to ORIF and its subgroup; however, the difference was not significant.

Conclusion: Compared to resection of radial head fractures in TTI, ORIF had significantly better ROM overall, but resection efficacy was better than ORIF when comparing the Mason type III fractures.