A neglected terrible triad of the elbow: A report case

Alban Cala *, Mohammed Amine Choukri, Yasser Sbihi, Hicham Arfaoui, Oussama El Adaoui, Yassir El Andaloussi, Ahmed Reda Haddoun, Driss Bennouna and Mustapha Fadili

Department of Traumatology and Orthopedic surgery, Ibn Rochd University Hospital Center, Casablanca, Morocco.
Case Study
World Journal of Advanced Research and Reviews, 2024, 22(03), 445–449
Article DOI: 10.30574/wjarr.2024.22.3.1731
Publication history: 
Received on 27 April 2024; revised on 06 June 2024; accepted on 08 June 2024
Background: The terrible triad of the elbow was described in 1996 by Hotchkiss and is defined by severe trauma involving posterior dislocation of the olecrana, fracture of the radial head and coronoid process. Management has been a therapeutic challenge in recent decades due to its difficult treatment and poor prognosis. We report a case of a neglected terrible triad of the elbow in a 68-year-old patient following a road accident that occurred 1 month before admission.
Methods: Mr B.M, 68 years old, presented to the emergency department for a closed trauma to his left elbow one month after his admission following a public road accident, it was a motorcyclist hit by a car, resulting in trauma to multiple points of impact including the skull, spine and left elbow. On the radiograph of the elbow face, there was a fracture of the radial head associated with a fracture of the coronoid process and posterior humeroolecranial dislocation. CT imaging made it possible to better visualize the fracture traits and classify them confirming the diagnosis of a terrible neglected triad of the elbow.
Results: The patient received surgery under general anesthesia, with a lateral first of the elbow, a fracture of the radial head with a fracture of the coronoid process in cal, after removal of the cal, reduction of the fracture of the head with installation of a mini T-plate, reduction of the olecrane and arthrodesis of the ulno-humeral joint by 02 pins in cross. Post-operative immobilization by a brachio-antebrachio-palmar splint was recommended.
Conclusion: The delay in taking charge of an unfortunate triad of the elbow engages the functional prognosis of the limb. Neglected fractures are still seen in our context and pose a real public health problem.
Terrible Triad; Elbow; Traumatology; Public Road accident; Neglected
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