Comparison of a single approach versus double approaches for the treatment of terrible traid of elbow-A retrospective study

Introduction: Dislocation of the elbow associated with radial head and coronoid fracture, the so-called "terrible triad" of the elbow, is challenging to treat and has a history of complicated outcomes. This study is to compare the clinical outcome of a single lateral approach-the extensile splitting extensor digitorum communis (EDC) approach and combined lateral and medial (CML) approaches for the treatment of terrible traid of the elbow (TTE). Material and methods: After appropriate exclusion, 60 TTE patients (28 patients in the EDC group, 32 patients in the CML group) from 2009 January to 2015 August were reviewed in this study. All included patients underwent open reduction, lateral collateral ligament complex repair, and postoperative function exercise. Surgical time, intraoperative blood loss, postoperative pain, elbow motion, MEPS score and complication rate were recorded and compared. Result: There were significant differences in surgery time (P < 0.05) and ulnar nerve lesion symptom, no patient suffered ulnar nerve lesion symptom in EDC group, but 5 patients in CML group suffered it. No differences were found in intraoperative blood loss, postoperative pain and heterotopic ossification (P > 0.05). Mean follow-up was 26.1 months (from 24 to 30 months), at the final follow-up, 2 patients in EDC group and 4 patients in CML group required elbow release operation, mean flexion and extension (124.1 +/- 14.6 degrees and 8.3 +/- 5.3 degrees), pronation and supination (73.4 +/- 5.3 degrees and 74.4 +/- 6.0 degrees) in EDC group were higher than CML group (114.2 +/- 15.0 degrees and 17.6 +/- 8.0 degrees, 69.2 +/- 6.9 degrees and 70.4 +/- 7.5 degrees, P < 0.05). Besides, MEPS score in the former group was also higher than the latter group (91.8 +/- 4.5 to 84.4 +/- 5.2, P < 0.01). Conclusion: The single lateral approach achieved better function recovery than combined lateral and medial approach, decreasing the risk of ulnar nerve lesion and surgery time for the treatment of TTE.