Surgical strategies for coronoid fixation in terrible triad elbow injuries: A comparative analysis of Tight-Rope and screw fixation.

BACKGROUND

The terrible triad of the elbow describes a complex injury pattern characterized by elbow subluxation or dislocation, rupture of the lateral ulnar collateral ligament (LUCL), and concomitant fractures of the radial head and coronoid process. This study aimed to evaluate and compare the clinical outcomes of patients with terrible triad injuries treated surgically at our institution, in whom coronoid fractures were managed using either screw fixation or the Tight-Rope technique.

METHODS

This retrospective cohort study included patients who underwent surgical treatment for terrible triad injuries between January 2017 and December 2023. Patients with Regan-Morrey type 2 or 3 coronoid fractures treated using the Tight-Rope technique were assigned to the Tight-Rope group, whereas those treated with screw fixation comprised the Screw group. Demographic characteristics, range of motion (ROM), visual analog scale (VAS) scores, and QuickDASH (Quick Disabilities of the Arm, Shoulder and Hand) scores at 3, 6, and 12 months postoperatively were analyzed. Patients with type 1 fractures, medial collateral ligament (MCL) injuries, follow-up <12 months, or a history of systemic infection were excluded.

RESULTS

Twenty-nine patients were included (11 in the Tight-Rope group and 18 in the Screw group). No significant differences were observed between the groups in terms of ROM or VAS and QuickDASH scores at 3, 6, and 12 months. After excluding cases requiring LUCL reconstruction and analyzing only patients who underwent LUCL repair (8 Tight-Rope, 13 Screw), the only statistically significant difference was a lower 12-month QuickDASH score in the Screw group. Complications included superficial cellulitis (1 Tight-Rope, 2 Screw) and heterotopic ossification (2 Tight-Rope, 3 Screw), all of which were managed conservatively. Post hoc power analysis based on 12-month QuickDASH scores, VAS scores, and elbow ROM (effect size d=0.77, α=0.05) demonstrated power of 77%, 71%, and 74%, respectively.

CONCLUSION

Functional outcomes were largely comparable between Tight-Rope and screw fixation techniques. These findings align with emerging evidence questioning the routine necessity of coronoid fixation and underscore the importance of individualized surgical decision-making.