Comparison of Radial Head Resection With Radial Head Fixation in the Terrible Triad Injury of the Elbow

Background: The optimal treatment of radial head component in the terrible triad injuries of the elbow is challenging. In this study, we compared the functional outcome and complication rates of radial head resection with radial head fixation in a terrible triad setting. Objectives: Comparison of radial head resection with radial head fixation in terrible triad. Methods: In the present retrospective study, the outcome of terrible triad injury in 41 patients, in whom the radial head component was managed with either radial head resection (n=28) or open reduction and internal fixation (n=13), was compared. The subjective assessments of the outcome included visual analog scale (VAS) for pain, ‎the Mayo elbow performance score (MEPS), and the disabilities of the arm, shoulder, and ‎hand (DASH) score. The objective assessment of outcome included the evaluation of elbow range of motion (ROM) and elbow stability. Results: The mean±SD age of the patients was 39.2±10.2 years. The demographic characteristics of the patients of the two study groups were not statistically different. The mean supination/pronation arc of motion was not significantly different between the two ‏study groups (P=0.11). The mean flexion/extension arc of motion was significantly more in the fixation group (P=0.001). The mean MEPS and DASH scores were not ‏significantly different between the study groups (P=0.22 and P=0.49, respectively). The mean ‏VAS was significantly more in the fixation group (P=0.04). All the elbows were stable at the last follow-up. The postoperative complications (arthrosis and heterotopic ossification) were considerably more in the resection group. Conclusion: Although comparable at function, the present study favors the radial head fixation whenever possible to avoid the postoperative complications of radial head reaction.