Shoulder Elbow iSAWE 7

Diagnosis

• Terrible triad injury, posterolateral rotatory dislocation with radial head and coronoid fractures
• Lateral ligament complex disruption, starting with the lateral ulnar collateral ligament (Horii circle)
• High risk of recurrent instability, stiffness and arthritis without surgery

Initial management

• Neurovascular examination, especially the ulnar nerve
• Prompt closed reduction under sedation and a well padded backslab at 90 degrees
• Post reduction radiographs and CT to define the radial head and coronoid fractures (Regan and Morrey, O’Driscoll)

Surgical principles

• Inside to out repair through a lateral approach
• Fix or repair the coronoid, often with sutures through drill holes for small tip fractures
• Fix or replace the radial head, which is an important secondary stabiliser
• Repair the lateral ulnar collateral ligament to the lateral epicondyle
• Check stability through range, and repair the medial collateral ligament or apply a hinged external fixator if still unstable
• Early active motion within the stable arc

Related pages

• Complex Elbow Instability
• Radial Head Replacement