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Comparison of different treatment approaches for coronoid process fracture in terrible triad injury: a multicenter, randomized controlled study

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Abstract

Purpose

The purpose of the study was to compare the functional results of different treatment approaches for the fracture of the coronoid process in terrible triad injury (TTI).

Methods

This prospective randomized controlled trial included participants from seven level-1 trauma centres in China. All patients were randomly assigned to three groups, wherein different approaches were applied to treat coronoid fracture: group A) internal fixation of the coronoid process without external fixation or splint (ORIF group), B) external fixation using a hinged fixator without internal fixation (Exfix group), and C) long-arm plaster for two to three weeks postoperatively without internal fixation of coronoid process (Plaster group). Early active motion exercises within the limits of pain were started immediately after surgery under the supervision of a physical therapist. Outcomes were evaluated at regular intervals over the subsequent 12 months.

Results

A total of 65 patients (22 patients in Group A, 21 in Group B, and 22 in Group C) were included in this trial from January 2016 to January 2019. The average arc of elbow motion was 114.1° ± 8.92°. The average flexion and flexion contracture were 126.4° ± 11.2° and 12.3° ± 7.7°, respectively. The arcs of forearm rotation of the elbow for each group were 145.41° ± 9.36°, 143.38° ± 9.79°, and 143.86° ± 10.95°, respectively. The MEPS for each group were 86.82 ± 9.7, 86.67 ± 9.92, and 85.23 ± 8.66, respectively. The DASH score for each group were 18.26 ± 19.31, 18.85 ± 15.02, and 20.19 ± 13.59, respectively.

Conclusion

All three approaches in our trial showed similar functional results in the long-term survey. Patients treated with external fixation without internal fixation of the coronoid process showed less pain during early mobilization and acquired maximum flexion within a short duration after surgery.

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Data Availability

All data generated or analyzed during this study are included in this published article.

Abbreviations

TTI :

Terrible triad injury

ORIF :

Open reduction and internal fixation

Exfix :

External fixation

MEPS :

Mayo Elbow Performance Score

DASH :

Disabilities of the arm, shoulder, and hand

RCT :

Randomized control trial

LUCL :

Lateral ulnar collateral ligament

MCLC :

Medial collateral ligament complex

HO :

Heterotopic ossification

HEF :

Hinged external fixation

RH :

Radial head

VAS :

Visual analog scale

ROM :

Range of motion

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Author information

Author notes

  1. Shengdi Lu and Yanmao Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Shengdi Lu, Yanmao Wang, Biyu Rui & Jian Ding

Authors
  1. Shengdi Lu
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  2. Yanmao Wang
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  3. Biyu Rui
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  4. Jian Ding
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Contributions

JD contributed to the study conception and design. Material preparation, data collection, and analysis were performed by BR. The first draft of the manuscript was written by SL and YW. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jian Ding.

Ethics declarations

Ethics approval

The study was a level-I multicenter RCT study and was registered in the Chinese Clinical Trial Registry (number: ChiCTR-INC-17014197). All procedures were performed according to the Declaration of Helsinki, and the Institutional Review Board approved all procedures performed (IRB number: YS-2017-89).

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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The authors affirm that human research participants provided informed consent for publication of the images in Figures.

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The authors declare no competing interests.

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Supplementary information

ESM 1

Figure S1. After 7 months, radiograph showed no sign of instability (A, B), and good elbow function was achieved(C ~ F). Figure S2. Satisfied functional results were noted at 9-month follow-up.

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Lu, S., Wang, Y., Rui, B. et al. Comparison of different treatment approaches for coronoid process fracture in terrible triad injury: a multicenter, randomized controlled study. International Orthopaedics (SICOT) 47, 2103–2111 (2023). https://doi.org/10.1007/s00264-023-05864-0

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