The anconeus-triceps lateral flap approach in terrible triad of the elbow: good outcome in a series of ten cases

• Published in: Annals of medicine and surgery Vol. 86; no. 8; pp. 4352 - 4357
• Main Authors: Le, Gia Anh Thy, To, Kha, Dang, Nghia Thanh, Nguyen, Viet Tan, Phan, Tri Nguyen, Nguyen, Van Thai, Ton, Thi Thanh Thao, Vo, Thanh Toan
• Format: Journal Article
• Language: English
• Published: England Lippincott Williams & Wilkins 01-08-2024
• Subjects: Original Research; terrible triad of the elbow; anconeus-triceps lateral flap approach; case series; posterior approach
• ISSN: 2049-0801; 2049-0801
• DOI: 10.1097/MS9.0000000000002211

Standard surgical management for the terrible triad of the elbow (TTE) has been established since 2004, yet postoperative complications are common and consensus on optimal management is absent. Different surgical algorithms for treating TTE and their efficacy have been reported worldwide, yet evidence from Vietnam remains limited.
Ten cases diagnosed with TTE admitted to the Hospital of Traumatology and Orthopedics, a tertiary orthopedic center in Ho Chi Minh City, were presented to demonstrate the effectiveness and rate of postoperative complications following our stepwise surgical procedures using the anconeus-triceps lateral flap approach. The intraoperative "drop sign", quantitative assessment of pain and level of upper arm disability (via VAS and QuickDASH score) was mentioned to assess the algorithm's benefit. All patients' information was retrieved from medical records from August 2022 to January 2024.
All 10 cases required repair of the lateral ligament complex and underwent surgery within 2 days of hospitalization. Immediate postoperative imaging revealed no drop sign, and none of the patients experienced elbow dislocation nor the need for repeated surgery, and a full range of elbow motion was demonstrated at 3-6 months follow-up.
TTE is a challenging injury that almost always obligates surgical correction. The anconeus-triceps lateral flap approach, with its advantages of better visualization and preservation of certain essential stabilizing muscles of the elbow, was demonstrated to yield a high success rate and low postoperative complication rate.