Short-Term Patient Outcomes after Placement of an Internal Joint Stabilizer for Terrible Triad Injuries: A Multicenter Study

Daniel A London; Erica Umpierrez; Gabrielle Notorgiacomo; Phillip R Ross; Michael Wigton; John D Wyrick; Reed W Hoyer

doi:10.1016/j.jhsa.2023.04.003

Short-Term Patient Outcomes after Placement of an Internal Joint Stabilizer for Terrible Triad Injuries: A Multicenter Study

J Hand Surg Am. 2023 May 16:S0363-5023(23)00179-X. doi: 10.1016/j.jhsa.2023.04.003. Online ahead of print.

Authors

Daniel A London¹, Erica Umpierrez², Gabrielle Notorgiacomo³, Phillip R Ross⁴, Michael Wigton⁵, John D Wyrick⁴, Reed W Hoyer⁶

Affiliations

¹ Department of Orthopaedic Surgery, University of Missouri, Columbia, MO. Electronic address: d.london@health.missouri.edu.
² Department of Orthopaedic Surgery, Conway Medical Center, Myrtle Beach, SC.
³ University of Cincinnati School of Medicine, Cincinnati, OH.
⁴ Department of Orthopaedic Surgery, University of Cincinnati, OH.
⁵ Beacon Orthopedics, Cincinnati, OH.
⁶ Indiana Hand to Shoulder Center, Indianapolis, IN.

PMID: 37191606
DOI: 10.1016/j.jhsa.2023.04.003

Abstract

Purpose: The purpose of this study was to assess the functional and patient-reported outcomes after the use of the internal joint stabilizer (IJS) for unstable terrible triad injuries. Specifically, we sought to determine our complication rate and the impact of complications on patient outcomes.

Methods: We identified all patients who had an IJS placed as a supplemental fixation for a terrible triad injury at two urban, level 1 academic medical centers. We reviewed these patients' charts for demographic information, complication profiles, postoperative range of motion (ROM), and pain-level data. We also collected the QuickDASH and Patient-Rated Elbow Evaluation (PREE) scores. Descriptive statistics were reported. Final visit data were compared between patients who returned to the OR for a complication and those who did not.

Results: From 2018 to 2020, 29 patients had an IJS placed for a terrible triad injury. The median final follow-up was 6.3 months after surgery (IQR: 6.2 months). There were 38 complications in 19 patients (65.5%) that required 12 patients to return to the OR (41.3%) for procedures beyond simple IJS removal. There were no significant differences in the ROM between patients who returned to the OR for a complication and those who did not. QuickDASH and PREE scores were greater (indicating more disability) in patients who had a complication that required a secondary surgical procedure.

Conclusions: Patients who receive an IJS incur a high rate of complications. When patients sustain complications that require secondary surgeries, their ultimate functional outcome scores worsen.

Type of study/level of evidence: Therapeutic IV.

Keywords: Elbow instability; elbow trauma; internal joint stabilizer; terrible triad.