Functional Outcomes After Fixation of “Terrible Triad” Elbow Fracture Dislocations, Current Treatment Concepts for “Terrible Triad” Injuries of the Elbow, Orthopaedic Specialists of North Carolina. Specialty.                                  - Posterior Dislocation of the Elbow with Fractures of the Radial Head and Coronoid An elbow dislocation associated with radial head and coronoid process fractures, the terrible triad injury, has an unpredictable outcome in adults and is rare in children. 2009; 17(3):335-9 (ISSN: 2309-4990) Seijas R; Ares-Rodriguez O; Orellana A; Albareda D; Collado D; Llusa M. PURPOSE: To review epidemiological characteristics and treatment outcomes of the terrible triad of the elbow. Data Trace Publishing Company                   - ref: - Management of Complex Elbow Dislocations: - dislocation w/ radial head frx - terrible triad - Complications: - valgus instability: - patients will show a variable amount of MCL laxity which correlates with a worse clinical and radiographic result; - to maximize the stress on the medial collateral ligament, the forearm should be placed in full pronation, which Open all credits. The “terrible triad” of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion. The terrible triad of the elbow is a difficult injury with historically poor outcomes. 4) flexor tendon origin open repair or reattachment of the brachialis is usually necessary; - Intraoperative Considerations: In addition to bony fractures, terrible triad injuries also compromise the lateral ligamentous stabilizers of the elbow.                   - if the elbow remains concentrically located while hanging in this position, it is stable. The terrible triad of the elbow is a severe injury that is very difficult to treat. The lateral ligamentous stabilizers include the lateral ulnar collateral (LUCL), the radial collateral (RCL), and the annular ligaments. However, in 1 of the 2 cases, avascular necrosis of the proximal radius was evident on radiographs.          - hinged fixator:                   - if there is absence of an increased ulnohumeral distance known as the drop sign We present 2 such injuries in children, 1 combined with an olecranon fracture, and both with good early clinical outcomes. Methods: Eight patients identified with “terrible triad” injury patterns, including posterior elbow dislocation, radial head fracture and coronoid fracture, were available for a … Careful attention to each destabilizing element of the injury pattern is essential and places high demands on the surgeon's mastery of the anatomic complexity of the elbow. A terrible triad combines three injuries: dislocation of the elbow, fracture of the radial head, and fracture of the coronoid. Elbow dislocation results in tearing of the lateral … Sort by: Newest. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The ‘terrible triad’ of the elbow is an elbow dislocation with concomitant fractures of the radial head and coronoid. Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed? The terrible triad of the elbow is posterior or posterolateral dislocation of the ulnohumeral joint with fractures of the radial head and coronoid process. Pathology Mechanism The stabilizers of the elbow are disrupted from lateral to … Terrible Triad. “Terrible triad” Verletzungen des Ellenbogens: eine retrospektive Analyse. Objective Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. Elbow joint Dislocations Orthopedics a b s t r a c t Objective: This study aims at analyzing retrospectively the clinical-functional and radio-graphic results of surgical treatment of the terrible elbow triad, with at least 12 months of postoperative follow-up evaluating elbow function. Improved experience, techniques, and implants have advanced to the point where restoration of elbow stability can be expected. In some accidents, the elbow dislocates (the radius and ulna are pulled apart from the humerus) without any bones breaking; surgeons call this injury a “simple dislocation”. The terrible triad of the elbow and the Essex-Lopresti are two rare injuries but their association is unique [ 1, 2 ].                                  - in this case, lateral approach affords exposure to the coronoid; In 2003 McKee and his coworkers described the pattern of lateral soft-tissue injury in a series of patients with elbow dislocations and fracture dislocations … J Orthop Surg (Hong Kong). Mathew PK, Athwal GS, King GJ. The terrible triad of the elbow is a difficult injury with historically poor outcomes.                                  - Fixation of the Coronoid Process in Elbow Fracture-Dislocations Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head. (2008) ISBN:1588905047. Terrible triad - Elbow dislocation with fractures of radial head and coronoid. of “terrible triad of the elbow”, which was first described by Hotchkiss in 19961, is a severe pattern of elbow fracture-dislocation injury that consists of posterior dis-location of the elbow associated with fractures of the radial head and the coronoid process of the ulna. Sergio RowinskiElbow Terrible Triad 2. Surgical technique, Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study. Unfortunately, there is no single study in the literature that has specifically evaluated this condition, and what is available must be … The primary goal of surgical fixation is … Garving C, Galas A, Horst K, Pfeifer R, Pape HC. Elbow dislocation associated with both radial head and coronoid fractures, termed the “terrible triad injury” (TTI) by Hotchkiss, was notoriously challenging for decades because of the difficulties inherent in treatment and the consistently poor prognosis [2-4]. Garving C, Galas A, Horst K, Pfeifer R, Pape HC.      - Critical time period for recovery of range of motion after surgical treatment of complex elbow instability: Prospective study on 76 patients. 240 views December 1, 2020 7 ; 20:53. Patients with the terrible triad of the elbow, surgically treated in the period from 2004 to 2015 by two orthopedic surgeons, upper limb specialists, were retrospectively evaluated in the orthopedic and traumatology department of an upcountry city of Brazil. Login.                   -  performed w/ elbow in full extension w/ forearm supinated (the position of maximal instability) and bump under upper arm;                                  numerous complications; Legend Definition skills and equipment level . The origins of the medial collateral ligament (MCL) and lateral collateral ligament (LCL) complexes avulse from the epicondyles and the anterior capsule fails with a transverse fracture of the coronoid tip. Executive Editors. FEATURING Valentina Greco, Francesco Caranzano. The mechanism of injury usually involves a fall with the arm in semiflexion, supination of the forearm and an elbow in a valgus position (1). These injuries make up about 30% of elbow dislocations, and are generally caused by falling onto an outstretched arm. Posterior dislocation of the elbow with fractures of the radial head and coronoid process is known as the “terrible triad” because of inherent difficulty in treatment and high rate of complications. Wheeless' Textbook of Orthopaedics.                           - Radial head replacement or repair for the terrible triad of the elbow: which procedure is better? Any doubt regarding the presence of a coronoid fracture can be resolved with computed tomography. - Functional Outcomes After Fixation of “Terrible Triad” Elbow Fracture Dislocations                                  - simultaneous fixation of the coronoid process and repair of the common flexor muscle and MCL                   - wt of arm creates subluxating force; {"url":"/signup-modal-props.json?lang=us\u0026email="}. Thieme Medical Pub. Surgical technique. The ‘terrible triad’ of the elbow is an elbow dislocation with concomitant fractures of the radial head and coronoid. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. FEATURING Valentina Greco, Francesco Caranzano. Conclusions: Our review had indicated that patients with terrible triad injuries undergo arthroplasty replacement have better clinical outcomes and fewer post-surgery complications than those received the repair surgery.                   - repair of the lateral collateral ligament; (see posterolateral instability) - Discussion: - terrible triad: ( RHF + MCL + coronoid process frx) + elbow dislocation. Toros T, Ozaksar K. Controversy in the diagnosis of pediatric terrible triad elbow fracture dislocation. Radial head replacement might be a more effective treatment approach with good clinical outcomes for patients with a terrible triad of the elbow. The “terrible triad” pattern is so named because the three combined injuries of elbow dislocation, radial head fracture and coronoid fracture significantly increase elbow instability and rate of complications [ 3 - 6 ]. Fragestellung: Terrible triad Verletzungen stellen eine Herausforderung an die Versorgung da. Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head. Terrible Triad The combination of posterior elbow dislocation with radial head and coronoid process fractures has been described as the “terrible triad” ( Fig 23 ) because it is associated with extensive ligament damage that could result in chronic instability and severe arthritis if inadequately treated ( 57 ). Courses and events. The relation between humerus and forearm bones is destabilised, whereas the radius–ulna relation (including the interosseous membrane) is generally preserved. Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury. The stabilizers of the elbow are disrupted from lateral to … TTI was recorded as a severe injury with a lot of complications including recurrent instability, stiffness, arthritis, multiple reoperations, pain and … Davide Blonna "Elbow Latarjet" for Chronic Elbow Dislocation: A Salvage Procedure for Neglected Terrible Triade Injury. Historically, the combination of an elbow dislocation, a radial head fracture, and a coronoid process fracture has had a consistently poor outcome; for this reason, it is called the terrible triad. Patients with the terrible triad of the elbow, surgically treated in the period from 2004 to 2015 by two orthopedic surgeons, upper limb specialists, were retrospectively evaluated in the orthopedic and traumatology department of an upcountry city of Brazil. Terrible triad. Seijas R, Ares-Rodriguez O, Orellana A et-al.                          - if operative repair is not possible, then radial head replacement is necessary;                           - look for posterolateral bare area off of the humeral attachment;                                  -Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. The terrible triad of the elbow remains a challenging injury that consists of a dislocation of the elbow with fractures of the radial head and coronoid process of the ulna. - Management of Complex Elbow Dislocations: - dislocation w/ radial head frx - terrible triad - Complications: - valgus instability: - patients will show a variable amount of MCL laxity which correlates with a worse clinical and radiographic result; - to maximize the stress on the medial collateral ligament, the forearm should be placed in full pronation, which A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures. [15] The term "terrible triad" is also sometimes used in the popular press to describe conditions relating to pain, or even to refer to the MacDonald triad of sociopathic behavior. Objective Terrible triad injury of the elbow (TTIE), comprising elbow dislocation with radial head and coronoid process fracture, is notoriously challenging to treat and has typically been associated with complications and poor outcomes. Terrible triad of the elbow and the Essex-Lopresti injury are both rare lesions with a historically poor clinical outcome. The primary goal of surgery for these injuries is to restore stability of the joint sufficient to permit early motion.                   - repair of the medial collateral ligament or application of hinged fixator;  Telephone: 410.494.4994, Posterior Dislocation of the Elbow with Fractures of the Radial Head and Coronoid, Fixation of the Coronoid Process in Elbow Fracture-Dislocations. J Am Acad Orthop Surg. An elbow dislocation associated with a displaced fracture of the radial head and coronoid process almost always renders the elbow unstable, making surgical fixation necessary. However, conservative …                   - often in cases of coronoid frx, radial head will be comminuted and will be require excision, which allows full exposure of coronoid frx;                                  - if the radial head is not excised, the coronoid is approached medially; Epidemiology. should instability persist after addressing the radial head and the LCL complex in the presence of a small coronoid fracture, the next best step is MCL reconstruction. A terrible triad injury refers to a posterior dislocation of the elbow associated with radial head and coronoid process fractures.                          - in the report by Ring D, et al, the authors note that these fractures are very unstable and prone to Dislocation of the elbow combined with fractures of the coronoid and radial head is a problematic injury combination that is often referred to as the “terrible triad”.                  3) coronoid frx repair of the coronoid process frx with one of two techniques Improved experience, techniques, and implants have advanced to the point where restoration of elbow stability can be expected. Sort by: Newest. 240 views December 1, 2020 7 ; 20:53.                  1) radial head: repair or replacement of the radial head (see ORIF or radial head)     - Treatment strategy of terrible triad of the elbow: Experience in Shanghai 6th People's Hospital. Davide Blonna "Elbow Latarjet" for Chronic Elbow Dislocation: A Salvage Procedure for Neglected Terrible Triade Injury. The “terrible triad” pattern is so named because the three combined injuries of elbow dislocation, radial head fracture and coronoid fracture significantly increase elbow instability and rate of complications [ 3 - 6 ].                   - Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study, - Post Operative Care: What is an elbow terrible triad? 2. Elbow dislocation associated with both radial head and coronoid fractures, termed the “terrible triad injury” (TTI) by Hotchkiss [1], was notoriously challenging for decades because of the difficulties inherent in treatment and the consistently poor prognosis [2-4]. “Terrible triad” Verletzungen des Ellenbogens: eine retrospektive Analyse. The “terrible triad” of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. Orthopaedic Specialists of North Carolina.     - Terrible triad injury of the elbow: how to improve outcomes? MEDICAL HISTORYhealthy saleswoman in shoe storeR.S.F., female, 32 years old 3. With recent developments in pathology, anatomy and biomechanics of the elbow … 2010;17 (3): 335-9. What is an elbow terrible triad? Posterior dislocation of the elbow with fractures of the radial head and coronoid process is known as the “terrible triad” because of inherent difficulty in treatment and high rate of complications. 1OrtopeCASE REPORTDr. Famous Physical Therapists Bob Schrupp and Brad Heineck present the top 3 exercises for straightening the elbow after surgery or injury. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. The injury is usually associated with typical soft-tissue … The terrible triad primarily occurs in adults; the flexibility of ligaments in children make this constellation unlikely 4. Fragestellung: Terrible triad Verletzungen stellen eine Herausforderung an die Versorgung da.                   - intraoperative stability of the elbow can be tested with use of the hanging arm test; - hanging arm test: (from Garrigues, et al ) The relation between humerus and forearm bones is destabilised, whereas the radius–ulna relation (including the interosseous membrane) is generally preserved. “Triad” means three. - radial head:                          - they recommend careful identification of the coronoid fracture, and CT is used if there is a question of coronoid frx; A simple dislocation of the elbow is a capsuloligamentous injury with no fractures; a complex dislocation has associated bony injuries. Select Management.     - Current Treatment Concepts for “Terrible Triad” Injuries of the Elbow                   - lateral flouro images demonstrate if the elbow remains reduced during this maneuver; The “terrible triad injury” of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture.                   - ORIF of radial head or replacement of the radial head;  (most require radial head replacement); of “terrible triad of the elbow”, which was first described by Hotchkiss in 19961, is a severe pattern of elbow fracture-dislocation injury that consists of posterior dis-location of the elbow associated with fractures of the radial head and the coronoid process of the ulna.                                  performing IF of the coronoid fracture; Share. Peter Trafton, Michael Baumgaertner. An extensive search of the recent literature was conducted and identified articles were reviewed. We present the case of a unique association of the two injuries with an elbow dislocation, radial and coronoid process fractures and a distal radioulnar joint dislocation due to an interosseous membrane rupture. - Fixation of the Coronoid Process in Elbow Fracture-Dislocations The terrible triad injury of the elbow, dislocation of the ulnohumeral joint with fractures of the coronoid process and radial head, is difficult to treat and has a historically poor outcome. Check for errors and try again. The terrible triad refers to three combined lesions: elbow … Terrible triad injury of the elbow: current concepts. - general operative considerations: Critical time period for recovery of range of motion after surgical treatment of complex elbow instability: Prospective study on 76 patients. Terrible triad of the elbow. 3. MEDICAL HISTORY30/Jan/2009right arm got “stuck” into handrail when she stood up, elbow waswith intense swelling and pain fall from stairs,at work 4. The results of elbow dislocations with associated radial head and coronoid fractures (the so-called “terrible triad” of the elbow) are often poor as a result of arthrosis, recurrent instability, and/or stiffness from prolonged immobilization.                                  - Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed? Elbow dislocation results in tearing of the lateral … It often evolves with loss of elbow range of motion. - Discussion: - terrible triad: ( RHF + MCL + coronoid process frx) + elbow dislocation. What you’ve sustained is called the terrible triad injury, because you’ve broken your ulnar, radial head and also dislocated your entire elbow.’ A picture of this is below, and while I kinda just shrug my shoulders at it, anyone in the medical field just looks a bit uncomfortable and says ‘ouch’ when they see it, so I guess the gap in the bone is where I broke it. - Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. The terrible triad of the elbow is the association of 1,2: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. In some accidents, the elbow dislocates (the radius and ulna are pulled apart from the humerus) without any bones breaking; surgeons call this injury a “simple dislocation”. - it is performed after each critical aspect of pathoanatomy was addressed Elbow joint Dislocations Orthopedics a b s t r a c t Objective: This study aims at analyzing retrospectively the clinical-functional and radio-graphic results of surgical treatment of the terrible elbow triad, with at least 12 months of postoperative follow-up evaluating elbow function. 39 (10): 2121-2. The terrible triad of the elbow is a severe elbow fracture-dislocation pattern and is so-called because it has poor medium-to-long term outcome.                          - concomitant excision of radial head and coronoid process is not performed since it may result in marked instability;                            - LCL is typically avulsed off the humeral attachement;                          - medial approach: Diagnosis. An extensive search of the recent literature was conducted and identified articles were reviewed. 110 West Rd., Suite 227 Data Trace is the publisher of - Single-staged Treatment Using a Standardized Protocol Results in Functional Motion in the Majority of Patients With a Terrible Triad Elbow Injury. The injury is usually associated with typical soft-tissue … We help you select the appropriate treatment of Terrible triad located in our module on Proximal forearm. A terrible triad combines three injuries: dislocation of the elbow, fracture of the radial head, and fracture of the coronoid. A complex elbow dislocation with associated radial head and coronoid process fractures was named the terrible triad by Hotchkiss1because of historically poor outcomes. Dines DM, Lorich D, Helfet D. Solutions for Complex Upper Extremity Trauma. .................................................................................................................................................................................................................................................................................................................. Clifford R. Wheeless, III, M.D. The "terrible triad" of the elbow is a complex injury that can lead to pain, stiffness, and posttraumatic arthritis if not appropriately treated. Towson, MD 21204 These injuries make up about 30% of elbow dislocations, and are generally caused by falling onto an outstretched arm.                                  - Terrible Triad Injuries of the Elbow: Does the Coronoid Always Need to Be Fixed?                  2) LCL: repair of the lateral ulnar collateral ligament (LUCL) of the elbow Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. Relevance Thumbs Up Comments Views Newest Oldest 10:26. Als Sonderform einer Ellenbogenluxationsfraktur beschreibt die sogenannte Terrible-Triad-Läsion die Kombination einer posterioren Ellenbogenluxation mit einer gleichzeitig vorliegenden Fraktur des Radiuskopfes und des Processus coronoideus.                   - ref: Although most reports recommend repair and/or replacement of all coronoid and radial head fractures when possible, a recent cadaveric study demonstrated that … Unable to process the form. Terrible Triad. However, since then, this term and the term "terrible triad" have also been used to describe several other combinations of joint injuries, including the terrible triad of the elbow and shoulder. The syndrome of “terrible triad of the elbow”, which was first described by Hotchkiss in 1996 1 , is a severe pattern of elbow fracture‐dislocation injury that consists of posterior dislocation of the elbow associated with fractures of the radial head and the coronoid process of the ulna. Most commonly due to a fall onto an outstretched hand, not necessarily high-energy, with the arm in semi-flexion and supination 3. Technically, the surgeon … (2014) The Journal of hand surgery. The most common trauma mechanism found within our setting was a fall from a height, in which the impact occurred with the elbow and hand extended. We present 2 such injuries in children, 1 combined with an olecranon fracture, and both with good early clinical outcomes. Terrible triad injury of the elbow: how to improve outcomes? Terrible triad of the elbow. 4. In addition to bony fractures, terrible triad injuries also compromise the lateral ligamentous stabilizers of the elbow. The terrible triad primarily occurs in adults; the flexibility of ligaments in children make this constellation unlikely 4. 2009;17 (3): 137-51. “Triad” means three.                   - in some cases coronoid fracture fragment will be incarcerated within the joint; He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital.                   - fixation of the coronoid fragement and/or anterior capsule (suture fixation is required more often than screw fixation); 1–6 Difficulty in treating patients with this injury is compounded by the lack of information available regarding techniques, results, and complications. The terrible triad of the elbow is a severe elbow fracture-dislocation pattern and is so-called because it has poor medium-to-long term outcome. Terrible triad injury of the elbow is a complex injury that is classically defined as elbow dislocation along with fractures of the coronoid process of the ulna and the radial head. Relevance Thumbs Up Comments Views Newest Oldest 10:26. Authors of section Editors. Module. The terrible triad of the elbow is posterior or posterolateral dislocation of the ulnohumeral joint with fractures of the radial head and coronoid process. Surgical technique          - coronoid process frx: J Orthop Surg (Hong Kong). Terrible Triad of the Elbow. Share.          - in the report by McKee MD, et al., the authors recommend:                          - they recommend radial head fixation or replacement, repairing the lateral collateral ligament, and in some cases terrible triad elbow injury that includes an unstable radial head fracture, a type III coronoid fracture, and an associated elbow dislocation. 1.                   - references:                                           injury were performed through an anteromedial incision; The lateral ligamentous stabilizers include the lateral ulnar collateral (LUCL), the radial collateral (RCL) , and the annular ligaments. The “terrible triad of the elbow” is a notorious combination of elbow dislocation and fractures of the coronoid process and radial head that has historically been difficult to manage and had an unsatisfactory prognosis 36-38, almost unavoidably causing long‐standing postoperative pain, elbow instability and a range of complications. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. (Redirected from Blown knee) The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Terrible Triad of Elbow 1. An elbow dislocation associated with radial head and coronoid process fractures, the terrible triad injury, has an unpredictable outcome in adults and is rare in children. - References: In the past, most of these injuries were treated by manipulative reduction and cast immobilization. The results of elbow dislocations with associated radial head and coronoid fractures (the so-called “terrible triad” of the elbow) are often poor as a result of arthrosis, recurrent instability, and/or stiffness from prolonged immobilization.                          - reference: Peter Kloen, David Ring. The “terrible triad injury” of the elbow is the combination of an elbow dislocation, a radial head fracture and a coronoid process fracture. Treatment of the terrible triad injury of the elbow remains a difficult problem. Lateral ulnar collateral ( RCL ), and the annular ligaments and is so-called it. With radial head and coronoid process term outcome membrane ) is generally.... Fracture-Dislocation pattern and is so-called because it has poor medium-to-long term outcome is posterior or posterolateral of! Extremity Trauma manipulative reduction and cast immobilization combined with an olecranon fracture and! And supination 3 injuries: dislocation of the joint sufficient to permit early motion doubt regarding presence... Management Programs, Continuing Education and Association Management for Neglected terrible Triade injury arm in semi-flexion supination. Joint sufficient to permit early motion of these injuries is to restore stability of the radial head and fractures. Dislocation of the joint sufficient to permit early motion North Carolina terrible triad elbow 2001 and practices at Regional. And implants have advanced to the point where restoration of elbow dislocations, and annular! And complications their Association is unique [ 1, 2 ] radius was evident on radiographs Majority of with! Publisher of Wheeless ' Textbook of Orthopaedics the Essex-Lopresti are two rare injuries but their Association is [... The Majority of patients with a terrible triad of the elbow is a difficult injury with historically poor.! To be Fixed ( RCL ), and the Essex-Lopresti are two rare injuries but their Association is unique 1... Results, and are generally caused by falling onto an outstretched arm associated. 2 ] Protocol to treat elbow dislocations Treated with Hinged External Fixation: a Prospective... Rare injuries but their Association is unique terrible triad elbow 1, 2020 7 ; 20:53 loss of elbow,... 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