"Unhappy triad" of the trauma elbow in children: Diagnosis, classification, and mid-term outcomes.

IF 1.3 4区 医学 Q3 ORTHOPEDICS Journal of Childrens Orthopaedics Pub Date : 2023-11-16 eCollection Date: 2023-12-01 DOI:10.1177/18632521231211643
Tristan Langlais, Emmanuelle Louis, Alina Badina, Raphael Vialle, Stéphanie Pannier, Malo Le Hanneur, Franck Fitoussi
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Abstract

Background: The aim of this study was to describe the epidemiology, physiopathology, and outcomes of elbow "unhappy triad" trauma in children, combining a posterior dislocation, a proximal radius fracture, and a third lesion (i.e. bony or capsuloligamentous injury).

Methods: A retrospective bicentric study was conducted between 1999 and 2020. All skeletally immature children who presented to the emergency department and underwent surgery for a proximal radius injury were selected. Among this selection, only patients with two associated ipsilateral elbow injuries (i.e. posterior elbow dislocation and a bony and/or capsuloligamentous injury) were included. Active elbow ranges of motion, Mayo Elbow Performance Score and Quick-Disabilities Of The Arm, Shoulder And Hand scores and standard radiographs were recorded at last follow-up.

Results: Twenty-one patients met the inclusion criteria (mean age at surgery = 11.4 years) among 737 selected. The "unhappy triad" diagnosis was made preoperatively in nine cases (bone lesion only), intraoperatively in nine cases, and postoperatively in one case. The third lesions were surgically treated when the lesion was a bony fracture or if the elbow remains unstable between 60° and 90° of flexion (i.e. capsuloligamentous injury). Twenty patients were reviewed (mean follow-up = 5.8 years). The complications and re-operations rates were of 10%.

Conclusion: The "unhappy" triad of the child's elbow is a rare injury, where the preoperative diagnosis is frequently missed and lead to 10% of complications and re-operations.

Level of evidence: level III.

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儿童创伤肘的“不愉快三联征”:诊断、分类和中期结果。
背景:本研究的目的是描述儿童肘关节“不幸三联征”创伤的流行病学、生理病理学和结果,包括后路脱位、桡骨近端骨折和第三种病变(即骨或囊膜少韧带损伤)。方法:1999年至2020年进行回顾性双中心研究。所有骨骼发育不成熟的儿童都被选择到急诊科接受手术治疗桡骨近端损伤。在这一选择中,仅包括两种相关的同侧肘关节损伤(即肘后部脱位和骨和/或关节囊少韧带损伤)的患者。最后随访时记录肘关节活动度、Mayo肘关节功能评分和手臂、肩部和手部快速残疾评分以及标准x线片。结果:在入选的737例患者中,有21例符合入选标准(平均手术年龄11.4岁)。术前9例(仅骨病变),术中9例,术后1例进行“不愉快三联征”诊断。当病变为骨骨折或肘关节在屈曲60°至90°之间不稳定时(即关节囊寡锁损伤),则进行手术治疗。回顾了20例患者(平均随访时间为5.8年)。并发症及再手术率为10%。结论:儿童肘关节“不愉快”三联征是一种罕见的损伤,术前诊断经常漏诊,导致10%的并发症和再手术。证据等级:三级。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Childrens Orthopaedics
Journal of Childrens Orthopaedics Medicine-Orthopedics and Sports Medicine
CiteScore
2.70
自引率
14.30%
发文量
61
审稿时长
23 weeks
期刊介绍: Aims & Scope The Journal of Children’s Orthopaedics is the official journal of the European Paediatric Orthopaedic Society (EPOS) and is published by The British Editorial Society of Bone & Joint Surgery. It provides a forum for the advancement of the knowledge and education in paediatric orthopaedics and traumatology across geographical borders. It advocates an increased worldwide involvement in preventing and treating musculoskeletal diseases in children and adolescents. The journal publishes high quality, peer-reviewed articles that focus on clinical practice, diagnosis and treatment of disorders unique to paediatric orthopaedics, as well as on basic and applied research. It aims to help physicians stay abreast of the latest and ever-changing developments in the field of paediatric orthopaedics and traumatology. The journal welcomes original contributions submitted exclusively for review to the journal. This continuously published online journal is fully open access and will publish one print issue each year to coincide with the EPOS Annual Congress, featuring the meeting’s abstracts.
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