Anterior capsule re-attachment in terrible triad elbow injury with coronoid tip fracture

Abstract Background During the surgical treatment of terrible triad elbow injury (TTEI), the usefulness of re-attaching the anterior joint capsule when the coronoid tip is fractured remains unclear. The primary objective of this study was to assess potential benefits during surgery for TTEI of re-attaching the joint capsule when the coronoid tip is fractured. Hypothesis Re-attaching the anterior joint capsule in TTEI with a fractured coronoid tip improves clinical and radiological outcomes and decreases the complication and revision rates. Materials and methods This single-centre retrospective study included patients who underwent surgery at the acute phase of TTEI with a fractured coronoid tip. In all patients, a physical examination and elbow radiographs were performed at least 1 year after surgery. A statistical analysis was done to compare the groups with vs. without re-attachment of the anterior capsule and coronoid tip. Results The study included 30 patients, 16 females and 14 males, with a mean age of 51 years (range: 21–84 years). Among them, 11 did and 19 did not undergo re-attachment. The two groups were comparable regarding demographic features and follow-up duration. No significant differences were found at last follow-up for flexion-extension motion arc (p = 0.75), pronation-supination motion arc (p = 0.3051), or the Mayo Elbow Performance Score (p = 0.19). Radiographic evidence of humero-radial osteoarthritis was significantly more common in the absence of re-attachment (p = 0.04), whereas no differences were evidenced regarding humero-ulnar osteoarthritis (p = 0.73), the occurrence of subluxation or dislocation (p = 0.43), or loosening of the radial head implant (p = 0.47). The complication and revision rates were similar in the two groups. Conclusion In our experience, re-attaching the anterior capsule during the surgical treatment of TTEI with a coronoid tip fracture did not improve the clinical or radiographic outcomes after a mean follow-up of 54 months. Level of evidence IV, retrospective study.