{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:16:27Z","timestamp":1788315387206,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The morphology of fractures in the terrible triad of the elbow (TTE) is complex, and precise management relies on a profound understanding of this morphology. This study aims to systematically analyze, for the first time, the distribution and morphological characteristics of TTE fracture lines using three\u2010dimensional (3D) imaging technology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Clinical data and thin\u2010slice CT scans of 112 patients with TTE from January 2021 to December 2024 were retrospectively included. 3D fracture models were reconstructed using Mimics software. Virtual reduction and standardized alignment were performed using 3\u2010matic software. Fracture lines were mapped onto standard ulnar and radial templates, and 3D fracture heat maps were generated using the E\u20103D software to demonstrate the high\u2010frequency distribution zones of the fracture lines visually. Statistical analysis was performed using SPSS software (version 21.0, IBM Corp., Armonk, NY, USA). Continuous variables were compared using one\u2010way analysis of variance (ANOVA), and categorical variables were compared using the chi\u2010square test (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      test). A two\u2010tailed\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05 was considered statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study revealed distinct patterns in the distribution of TTE fracture lines. In the coronoid process, the fracture \u201chot zone\u201d presented as an annular high\u2010density band extending from the lateral middle aspect to the tip. In the radial head, an oblique high\u2010density band was observed in the anterolateral quadrant of the articular surface. The radial neck exhibited a circumferential high\u2010density zone, which was most prominent in the anterolateral aspect. Statistical analysis indicated a significant correlation between age and fracture complexity; the proportion of Regan\u2013Morrey type III coronoid fractures and Mason type III radial head fractures was significantly higher in elderly patients (&gt;\u200960\u2009years) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), suggesting that advanced age is a significant risk factor for complex fractures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study is the first to visually reveal the Collaborative Distribution Patterns of TTE fracture lines using 3D fracture mapping technology. This model provides morphological evidence for understanding the injury mechanism of TTE and offers an anatomical framework that may assist surgeons in individualizing surgical approaches and fixation strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/os.70399","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T03:18:25Z","timestamp":1786677505000},"page":"1981-1993","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Three\u2010Dimensional Fracture Mapping of the Terrible Triad of the Elbow: Morphological Characteristics and Clinical Implications"],"prefix":"10.1111","volume":"18","author":[{"given":"Shuo","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Hebei Medical University Third Hospital  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3631-8534","authenticated-orcid":false,"given":"Xinzhe","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hebei Medical University Third Hospital  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shibo","family":"Zhai","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hebei Medical University Third Hospital  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawen","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hebei Medical University Third Hospital  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hebei Medical University Third Hospital  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boan","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hebei Medical University Third Hospital  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyong","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hebei Medical University Third Hospital  Shijiazhuang Hebei China"},{"name":"Department of Emergency the Second Hospital of Shijiazhuang  Shijiazhuang Hebei China"},{"name":"Key Laboratory of Biomechanics of Hebei Province  Shijiazhuang Hebei China"},{"name":"NHC Key Laboratory of Intelligent Orthopaedic Equipment  Shijiazhuang Hebei China"},{"name":"Engineering Research Center of Orthopedic Minimally Invasive Intelligent Equipment Ministry of Education  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hebei Medical University Third Hospital  Shijiazhuang Hebei China"},{"name":"Department of Emergency the Second Hospital of Shijiazhuang  Shijiazhuang Hebei China"},{"name":"Key Laboratory of Biomechanics of Hebei Province  Shijiazhuang Hebei China"},{"name":"NHC Key Laboratory of Intelligent Orthopaedic Equipment  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7106-4649","authenticated-orcid":false,"given":"Lijie","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Hebei Medical University Third Hospital  Shijiazhuang Hebei China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-023-05864-0"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.27658"},{"key":"e_1_2_12_4_1","first-page":"12","article-title":"Clinical Efficacy Study of Surgical Treatment for Elbow Triad of Terror","volume":"28","author":"Ma R. 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