This surgical technique paper defines a standardized protocol for the terrible triad of the elbow: dislocation with radial head and coronoid fractures. It reports outcomes in 36 consecutive patients treated with sequential repair from the lateral approach. The goal is enough stability to permit early motion within days of surgery.
When you see an elbow dislocation with both radial head and coronoid fractures, treat it as a surgical injury: fewer than 5% are stable enough for closed management. The key mental model is that stability depends on both bone and ligament, so you must repair the coronoid, address the radial head, and reattach the lateral collateral ligament complex.
Work deep to superficial from the lateral side: coronoid first (it is deepest and buttresses against posterior subluxation), then radial head, then the LCL avulsion at the bare spot on the posterolateral condyle. Never resect the radial head alone; if it is unreconstructable, replace it with a metal modular head because it is a critical secondary stabilizer.
The whole point of stable fixation is to allow motion within days, since immobilization beyond three weeks produces a stiff elbow needing another operation.
This surgical technique paper defines a standardized protocol for the terrible triad of the elbow: dislocation with radial head and coronoid fractures. It reports outcomes in 36 consecutive patients treated with sequential repair from the lateral approach. The goal is enough stability to permit early motion within days of surgery.
When you see an elbow dislocation with both radial head and coronoid fractures, treat it as a surgical injury: fewer than 5% are stable enough for closed management. The key mental model is that stability depends on both bone and ligament, so you must repair the coronoid, address the radial head, and reattach the lateral collateral ligament complex.
Work deep to superficial from the lateral side: coronoid first (it is deepest and buttresses against posterior subluxation), then radial head, then the LCL avulsion at the bare spot on the posterolateral condyle. Never resect the radial head alone; if it is unreconstructable, replace it with a metal modular head because it is a critical secondary stabilizer.
The whole point of stable fixation is to allow motion within days, since immobilization beyond three weeks produces a stiff elbow needing another operation.