Because no report has been issued on the healing effects of low-intensity pulsed ultrasound on moderate to large fracture gaps, we performed an experimental study using acanineulna full-defect model. Ten mongrel male dogs were divided into two groups: a small defect group and large defect group. The defects were made on the middle one third of both ulnae and one side only was randomly selected for ultrasound sonication, at 1 MHz, 200 microsecond bursting sine wave in 50 mW/cm2 spacial average and temporal average. Sonication was started on the day after surgery and applied for 15 minutes once a day for six days a week. In the small defect group, the means of the radiologic scores, as described by Lane and Sandhu, were 0.6, 4.4, and 8.4 in the control side and 1.8, 6.0, and 10.4 in the treatment side one, three, and five months after the operation, respectively (p=0.0372). In the large defect model, the corresponding means were 2.2, 3.4, and 6.0 in the control side and 3.3, 5.4, and 9.2 in the treatment side (p= 0.009). Low-intensity pulsed ultrasound enhanced new bone formation in small and large full-defects and decreased the incidence of nonunion in the large defect model.
Animal ; Dogs ; Fractures/*physiopathology/*therapy ; Male ; Ulna/*injuries/*physiopathology ; Ultrasonic Therapy/*methods ; Wound Healing/*radiation effects

OBJECTIVETo study diagnosis and treatment methods of terrible triad of elbow.

METHODSFrom June 2001 to June 2009, 7 patients with terrible triad of elbow were reviewed. Among the patients, 6 patients were male and 1 patient was female, ranging in age from 20 to 68 years, averaged 36.5 years. All the fractures were fresh. All the patients were treated through a single lateral approach. The general approach was used to repair the damaged structures sequentially from deep to superficial, from coronoid to anterior capsule, to radial head, lateral ligament complex, and common extensor origin. The coronoid fractures and the radial head fractures were fixed with different methods according to fragments. The curative effiency were evaluated by Mayo elbow performance score (MEPS).

RESULTSAll the patients were followed up, and the duration ranged from 5 to 36 months, with a mean of 16.3 months. All the fractures were healed, and the healing time ranged from 3 to 6 months after operation (averaged 4.5 months). Four patients had heterotopic ossificatio. According to evaluation criteria, 2 patients got an excellent result, 4 fair and 1 bad. The average range of motion in elbow flexion-extension were 106.5 degrees (from -20 to 130 degrees), and the range of motion in forearm pronation-supination were 121 degrees (from 70 to 140 degrees). The patient with bad results were treated with radial head excised, and Kirschner fixation from posterior to anterior after reduction, which was found separate dislocation of the coronoid fracture on the X-ray after operation, and subluxation and instability of the elbow joint.

CONCLUSIONThe patients with terrible triad of elbow should be treated with operation actively. Follows are key to get an excellent result: treatment of bone and soft tissues at the same time, early rehabilitation after operation.

Adult ; Aged ; Elbow Joint ; injuries ; physiopathology ; Female ; Humans ; Joint Dislocations ; diagnosis ; physiopathology ; surgery ; Male ; Middle Aged ; Radius Fractures ; diagnosis ; physiopathology ; surgery ; Ulna Fractures ; diagnosis ; physiopathology ; surgery

OBJECTIVETo evaluate the clinical outcome of surgical treatment of the posterior dislocation of the elbow with coroniod and radial head fractures.

METHODSFrom January 2004 to March 2009, 9 patients with terrible triad of the elbow were reviewed. There were 7 males and 2 females (4 left elbows and 5 right elbows), with an average age of 41.2 years, ranged from 21 to 67 years. The radial head fractures were classified according to the Schatzker-Tile criteria: 4 patients had the fractures of type I, 3 patients had type II and 2 patients had type III. The ulnar coronoid fractures were classified according to the Regan-Morrey criteria: 2 patients had the fractures of type I, 5 patients had type II and 2 patients had type III. The general approach was used to repair the damaged structures sequentially from deep to superficial, through coronoid, anterior capsule, radial head, and lateral ligament complex to common extensor origin. If there was valgus instability in the elbow after the operation, the medial collateral ligament should be repaired with nonabsorption sutures. The plaster was applied for 7 to 10 days with elbow flexion in 90 degrees and the forearm in full pronation. Unrestricted motions and rehabilitation began at the 8th week after operation. Recovery of regular occupation depended on the degree of physical activity required, and it typically took 3 months for heavy physical laborers to return to work.

RESULTSAll the patients were followed up from 6 months to 5 years, with a mean duration of (31 +/- 6) months. At the 3rd month after operation, the mean rang of motion in flexion and extension of the elbow was (102 +/- 3) degrees (ranged from 80 degrees to 110 degrees), and the mean range of motion in pronation and supination of the forearm was (135 +/- 6) degrees (100 degrees to 150 degrees). According to the criteria of the Mayo scoreing system, the results were excellent in 5 cases, good in 3 cases, and fair in 1 case. Three patients had heterotopic ossification at the 6th month after operation. Among them, 2 patients had no effects on elbow function and were not treated, 1 patient had effects on flexion-extension of the elbow and was treated with resection of heterotopic ossification through lateral approach combined with early rehabilitation, the MEP score of the patient improved from fair to good.

CONCLUSIONThe key points for treating the terrible triad of the elbow are to restore the elbow normal anatomy and early rehabilitation to avoid the elbow stiff.

Adult ; Aged ; Elbow Joint ; injuries ; physiopathology ; Female ; Humans ; Joint Dislocations ; complications ; physiopathology ; surgery ; Male ; Middle Aged ; Radius Fractures ; complications ; physiopathology ; surgery ; Ulna Fractures ; complications ; physiopathology ; surgery

OBJECTIVETo study therapeutic effects of anteromedial approach combined with lateral approach for the treatment of terrible triad of elbow.

METHODSFrom November 2009 to March 2013,17 patients with terrible triad of elbow were treated through anteromedial approach combined with lateral approach. There were 11 males and 6 females, with an average age of 36.6 years old, ranging from 22 to 68 years old. Ten patients had fractures in the left side and 7 patients had fractures in the right side. All of which were close fractures. Coronoid process fractures were reduced and treated with internal fixation through the anteromedial approach, and the incision was located between radiocarpus and cubitalis grailis. In order to expose the lateral collateral ligament joint capsule and capitulum radii, Kocher approach was used with the incision between triceps brachii muscle and brachioradialis muscle along condylus lateralis humeri, down to posterior side between anconeus muscle and extensor carpi ulnaris muscle. Then capitulum radii fractures were treated with internal fixation using miniature plates and screws, and lateral collateral ligament complexes were repaired using fasciole rivets. Mayo elbow performance score (MEPS) was used to evaluate clinical effects at the latest follow-up.

RESULTSAll the patients were followed up, and the duration ranged from 13 to 24 months,with a mean of 12.4 months. At the latest follow-up, the average flexion angle of all patients was (134.0 ± 8.8) degrees; the average extension angle was (6.4 ± 2.3) degrees. According to the Mayo criteria system, the average total score was 91.8 ± 7.9, including pain score 42.4 ± 5.9, range of motion score 17.6 ± 2.6, joint stability score 9.7 ± 1.2, and functional score 22.1 ± 2.5; 13 patients got an excellent result and 4 good. Two patients had transient ulnar nerve palsy, and 1 patient had heterotopic ossification. There were no complications such as infection, nonunion, elbow residual instability, dislocation and elbow stiffness.

CONCLUSIONThe operation through anteromedial approach combined with lateral approach for the treatment of terrible triad of elbow has advantages of providing both bone and soft-tissue stability simultaneously, allowing early exercise and improving early functional recovery.

Adult ; Aged ; Elbow Joint ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Joint Dislocations ; physiopathology ; surgery ; Male ; Middle Aged ; Radius Fractures ; physiopathology ; surgery ; Ulna Fractures ; physiopathology ; surgery

OBJECTIVETo study therapeutic effects of comprehensive traditional Chinese medicine therapy for preventing postsurgery stiffness after operation for terrible triad of the elbow.

METHODSFrom December 2008 to December 2013,32 patients with elbow triad were randomly divided into two groups: therapy group and control group. There were 17 patients in control group including 12 males and 5 females with a mean age of (41.0 ± 7.1) years old. The patients in control group were received the past procedure therapy. There were 15 patients in therapy group, including 10 males and 5 females with a mean age of (41.3 ± 7.6) years old. The patients in therapy group were received comprehensive traditional Chinese medicine therapy, including passive exercise training at early stage (0 to 2 weeks after operation), transition from passive to active exercise training at middle stage (3 to 4 weeks after operation), and active exercise training at late stage (5 to 12 weeks after operation). Other treatment methods, such as orally taking or externally use of Chinese herbal medicine, manipulation and physiotherapy, were used at all stages. The Mayo Elbow Performance Score, patient satisfaction and complications were evaluated and analyzed.

RESULTSAll the patients were followed up, and the mean duration was 7.5 months. There were no complications such as internal fixation loosing, obvious displacement fracture and heterotopic ossification occurred. The Mayo score and patient satisfaction in therapy group were higher than those in control group (t = 12.78, P = 0.00; χ2 = 8.719, P = 0.003). Seven patients needed reoperation in control group, compared with 1 patient in therapy group (χ2 = 4.626, P = 0.032).

CONCLUSIONThe comprehensive traditional Chinese medicine therapy is effective to prevent postoperative stiffness after operation for terrible triad of the elbow by using different methods at different stages, which is worthy of spread and application.

Adult ; Case-Control Studies ; Elbow Joint ; injuries ; physiopathology ; surgery ; Female ; Humans ; Joint Dislocations ; surgery ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Movement ; Postoperative Complications ; prevention & control ; Radius Fractures ; surgery ; Ulna Fractures ; surgery