Functional Outcome of Radial Head Replacement and Lateral Ulnar Collateral Ligament (LUCL) Repair in Terrible Triad Injuries of the Elbow: Can Associated Type I Coronoid Fractures be Neglected?

Introduction: Type III coronoid fractures associated with terrible triad injuries of the elbow joint should always be stabilized. However, management of type I and type II fractures is debatable. In this study, we evaluate the functional outcome of neglecting type I coronoid fractures associated with terrible triad injury. Methods: This prospective study was conducted on 20 patients with a type I coronoid fracture in terrible triad fracture dislocations of the elbow. All the patients were managed by radial head replacement and repair of the lateral collateral ligament without any fixation of the coronoid fracture. All the patients were evaluated clinically and radiologically at final follow up of one year. The functional assessment of the elbow was done by Mayo Elbow Performance Score (MEPS). Results: The mean age of the patients was 36.3±9.2 years. Sixty five percent were male patients. The average flexion, pronation and supination at one year were 124o, 78o and 62o respectively. The average MEPS was 85 with excellent and good functional results in 85 % patients. Conclusion: In terrible triad injuries with type I coronoid fracture, the coronoid fracture can be neglected and stability achieved by radial head replacement and lateral collateral ligament repair.