{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:57:13Z","timestamp":1790888233469,"version":"4.1.0"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"the Ministry of Sciene and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety","award":["RS-2020-KD000040"],"award-info":[{"award-number":["RS-2020-KD000040"]}]},{"name":"Chonnam National University Hospital Biomedical Research Institute","award":["BCRI23063"],"award-info":[{"award-number":["BCRI23063"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The ideal treatment of terrble triad injuries and whether fixation of coronoid process fractures is needed or not are still debated. Therefore, we aimed to investigate if terrible triad injuries necessitate coronoid fracture fixation and evaluate if non-fixation treatments have similar efficacies and outcomes as fixation-treatments in cases of terrible triad injuries.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>From August 2011 to July 2020, 23 patients with acute terrible triad injuries without involvement of the anteromedial facet of the coronoid process were included to evaluate the postoperative clinical and radiological outcomes (minimum follow-up of 20 months). According to the preoperative height loss evaluation of the coronoid process and an intraoperative elbow stability test, seven patients underwent coronoid fracture fixation, and the other eight patients were treated conservatively. The elbow range of motion (ROM), Mayo Elbow Performance Score (MEPS), and modified Broberg-Morrey score were evaluated at the last follow-up. In addition, plain radiographs were reviewed to evaluate joint congruency, fracture union, heterotopic ossification, and the development of arthritic changes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>At the last follow-up, the mean arcs of flexion-extension and supination-pronation values were 118.2\u00b0 and 146.8\u00b0 in the fixation group and 122.5\u00b0 and 151.3\u00b0 in the non-fixation group, respectively. The mean MEPSs were 96.4 in the fixation group (excellent, nine cases; good, tow cases) and 96.7 in the non-fixation group (excellent, ten cases; good, two cases). The mean modified Broberg-Morrey scores were 94.0 in the fixation group (excellent, sevev cases; good, four cases) and 94.0 in the non-fixation group (excellent, ten cases; good, tow cases). No statistically significant differences in clinical scores and ROM were identified between the two groups. However, the non-fixation group showed a significantly lower height loss of the coronoid process than the fixation group (36.3% versus 54.5%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>There were no significant differences in clinical outcomes between the fixation and non-fixation groups in terrible triad injuries.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12893-024-02394-3","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T10:01:37Z","timestamp":1714039297000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Does the coronoid fracture in terrible triad injury always need to be fixed?"],"prefix":"10.1186","volume":"24","author":[{"given":"Yeong-Seub","family":"Ahn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong-Hwan","family":"Woo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sungmin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun-Hyuk","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae-Hoon","family":"An","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myung-Sun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,25]]},"reference":[{"key":"2394_CR1","unstructured":"Hotchkiss RN. Fractures and dislocations of the elbow. In: Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD, editors. Rockwood and Green\u2019s fractures in adults. 4th ed. Lippincott-Raven; 1996. pp. 929\u20131024."},{"key":"2394_CR2","doi-asserted-by":"publisher","first-page":"126","DOI":"10.1097\/00003086-198909000-00020","volume":"246","author":"PO Josefsson","year":"1989","unstructured":"Josefsson PO, Gentz CF, Johnell O, Wedeberg B. Dislocations of the elbow and intraarticular fractures. Clin Orthop Relat Res. 1989;246:126\u201330.","journal-title":"Clin Orthop Relat Res"},{"key":"2394_CR3","doi-asserted-by":"publisher","first-page":"547","DOI":"10.2106\/00004623-200204000-00006s","volume":"84","author":"D Ring","year":"2002","unstructured":"Ring D, Jupiter JB, Zilberfarb J. Posterior dislocation of the elbow with fractures of the radial head and coronoid. J Bone Joint Surg Am. 2002;84:547\u201351. https:\/\/doi.org\/10.2106\/00004623-200204000-00006s.","journal-title":"J Bone Joint Surg Am"},{"key":"2394_CR4","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.2106\/JBJS.I.01673","volume":"93","author":"GE Garrigues","year":"2011","unstructured":"Garrigues GE, Wray WH 3rd, Lindenhovius AL, Ring DC, Rush DS. Fixation of the coronoid process in elbow fracture-dislocations. J Bone Joint Surg Am. 2011;93:1873\u201381. https:\/\/doi.org\/10.2106\/JBJS.I.01673.","journal-title":"J Bone Joint Surg Am"},{"key":"2394_CR5","doi-asserted-by":"publisher","first-page":"117","DOI":"10.5397\/cise.2020.00234","volume":"23","author":"BS Kim","year":"2020","unstructured":"Kim BS, Cho CH. Radial head resection versus replacement for unreconstructable radial head fractures. Clin Shoulder Elb. 2020;23:117\u20138. https:\/\/doi.org\/10.5397\/cise.2020.00234.","journal-title":"Clin Shoulder Elb"},{"key":"2394_CR6","doi-asserted-by":"publisher","first-page":"173","DOI":"10.12671\/jkfs.2019.32.4.173","volume":"32","author":"JK Lee","year":"2019","unstructured":"Lee JK, Kim TH, Kim CK, Han SH. Open reduction and internal fixation in comminuted radial head fracture. J Korean Fract Soc. 2019;32:173\u201380. https:\/\/doi.org\/10.12671\/jkfs.2019.32.4.173.","journal-title":"J Korean Fract Soc"},{"key":"2394_CR7","doi-asserted-by":"publisher","first-page":"137","DOI":"10.5435\/00124635-200903000-00003","volume":"17","author":"PK Mathew","year":"2009","unstructured":"Mathew PK, Athwal GS, King GJ. Terrible triad injury of the elbow: current concepts. J Am Acad Orthop Surg. 2009;17:137\u201351. https:\/\/doi.org\/10.5435\/00124635-200903000-00003.","journal-title":"J Am Acad Orthop Surg"},{"key":"2394_CR8","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.2106\/00004623-200406000-00002","volume":"86","author":"DM Pugh","year":"2004","unstructured":"Pugh DM, Wild LM, Schemitsch EH, King GJ, McKee MD. Standard surgical protocol to treat elbow dislocations with radial head and coronoid fractures. J Bone Joint Surg Am. 2004;86:1122\u201330. https:\/\/doi.org\/10.2106\/00004623-200406000-00002.","journal-title":"J Bone Joint Surg Am"},{"key":"2394_CR9","doi-asserted-by":"publisher","first-page":"547","DOI":"10.2106\/00004623-200405000-00013","volume":"86","author":"AG Schneeberger","year":"2004","unstructured":"Schneeberger AG, Sadowski MM, Jacob HA. Coronoid process and radial head as posterolateral rotatory stabilizers of the elbow. J Bone Joint Surg Am. 2004;86:547\u201351. https:\/\/doi.org\/10.2106\/00004623-200405000-00013.","journal-title":"J Bone Joint Surg Am"},{"key":"2394_CR10","doi-asserted-by":"publisher","first-page":"75","DOI":"10.2106\/JBJS.H.00893","volume":"90","author":"GJ Zeiders","year":"2008","unstructured":"Zeiders GJ, Patel MK. Management of unstable elbows following complex fracture-dislocations-the \u2018terrible triad\u2019 injury. J Bone Joint Surg Am. 2008;90:75\u201384. https:\/\/doi.org\/10.2106\/JBJS.H.00893.","journal-title":"J Bone Joint Surg Am"},{"key":"2394_CR11","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1016\/j.jse.2006.06.015","volume":"16","author":"DM Beingessner","year":"2007","unstructured":"Beingessner DM, Stacpoole RA, Dunning CE, Johnson JA, King GJ. The effect of suture fixation of type I coronoid fractures on the kinematics and stability of the elbow with and without medial collateral ligament repair. J Shoulder Elb Surg. 2007;16:213\u20137. https:\/\/doi.org\/10.1016\/j.jse.2006.06.015.","journal-title":"J Shoulder Elb Surg"},{"key":"2394_CR12","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.2106\/00004623-200012000-00009","volume":"82","author":"RF Closkey","year":"2000","unstructured":"Closkey RF, Goode JR, Kirschenbaum D, Cody RP. The role of the coronoid process in elbow stability. A biomechanical analysis of axial loading. J Bone Joint Surg Am. 2000;82:1749\u201353.","journal-title":"J Bone Joint Surg Am"},{"key":"2394_CR13","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1016\/j.hcl.2004.07.004","volume":"20","author":"MS Cohen","year":"2000","unstructured":"Cohen MS. Fractures of the coronoid process. Hand Clin. 2000;20:443\u201353. https:\/\/doi.org\/10.1016\/j.hcl.2004.07.004.","journal-title":"Hand Clin"},{"key":"2394_CR14","doi-asserted-by":"publisher","first-page":"263","DOI":"10.2106\/00004623-200012000-00009","volume":"65","author":"KA Egol","year":"2007","unstructured":"Egol KA, Immerman I, Paksima N, Tejwani N, Koval KJ. Fracture-dislocation of the elbow functional outcome following treatment with a standardized protocol. Bull NYU Hosp Jt Dis. 2007;65:263\u201370. https:\/\/doi.org\/10.2106\/00004623-200012000-00009.","journal-title":"Bull NYU Hosp Jt Dis"},{"key":"2394_CR15","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1302\/0301-620X.94B1.26530","volume":"94","author":"IH Jeon","year":"2012","unstructured":"Jeon IH, Sanchez-Sotelo J, Zhao K, An KN, Morrey BM. The contribution of the coronoid and radial head to the stability of the elbow. J Bone Joint Surg Br. 2012;94:86\u201392. https:\/\/doi.org\/10.1302\/0301-620X.94B1.26530.","journal-title":"J Bone Joint Surg Br"},{"key":"2394_CR16","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.1007\/s11999-014-3471-7","volume":"472","author":"LK Papatheodorou","year":"2014","unstructured":"Papatheodorou LK, Rubright JH, Heim KA, Weiser RW, Sotereanos DG. Terrible triad injuries of the elbow: does the coronoid always need to be fixed? Clin Orthop Relat Res. 2014;472:2084\u201391. https:\/\/doi.org\/10.1007\/s11999-014-3471-7.","journal-title":"Clin Orthop Relat Res"},{"key":"2394_CR17","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1067\/mse.2000.106082","volume":"9","author":"N Terada","year":"2000","unstructured":"Terada N, Yamada H, Seki T, Urabe T, Takayama S. The importance of reducing small fractures of the cornoid process in the treatment of unstable elbow dislocation. J Shoulder Elb Surg. 2000;9:344\u20136. https:\/\/doi.org\/10.1067\/mse.2000.106082.","journal-title":"J Shoulder Elb Surg"},{"key":"2394_CR18","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1016\/j.jhsa.2007.06.019","volume":"32","author":"C Forthman","year":"2007","unstructured":"Forthman C, Henket M, Ring DC. Elbow dislocation with intraarticular fracture: the results of operative treatment without repair of the medial collateral ligament. J Hand Surg Am. 2007;32:1200\u20139. https:\/\/doi.org\/10.1016\/j.jhsa.2007.06.019.","journal-title":"J Hand Surg Am"},{"key":"2394_CR19","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1016\/j.jhsa.2008.02.007","volume":"33","author":"AL Lindenhovius","year":"2008","unstructured":"Lindenhovius AL, Jupiter JB, Ring D. Comparison of acute versus subacute treatment of terrible triad injuries of the elbow. J Hand Surg Am. 2008;33:920\u20136. https:\/\/doi.org\/10.1016\/j.jhsa.2008.02.007.","journal-title":"J Hand Surg Am"},{"key":"2394_CR20","doi-asserted-by":"publisher","first-page":"519","DOI":"10.5435\/00124635-200808000-00013","volume":"16","author":"CP Steinmann","year":"2008","unstructured":"Steinmann CP. Coronoid process fracture. J Am Acad Orthop Surg. 2008;16:519\u201329.","journal-title":"J Am Acad Orthop Surg"},{"key":"2394_CR21","doi-asserted-by":"publisher","first-page":"612","DOI":"10.1007\/s00776-010-1515-8","volume":"15","author":"WK Jeong","year":"2010","unstructured":"Jeong WK, Oh JK, Hwang JH, Hwang SM, Lee WS. Results of terrible triads in the elbow: the advantage of primary restoration of medial structure. J Orthop Sci. 2010;15:612\u20139. https:\/\/doi.org\/10.1007\/s00776-010-1515-8.","journal-title":"J Orthop Sci"},{"key":"2394_CR22","doi-asserted-by":"publisher","first-page":"96","DOI":"10.3944\/AOTT.2012.2632","volume":"46","author":"T Toros","year":"2012","unstructured":"Toros T, Ozaksar K, S\u00fcg\u00fcn TS, Kayalar M, Bal E, Ada S. The effect of medial side repair in terrible triad injury of the elbow. Acta Orthop Traumatol Turc. 2012;46:96\u2013101. https:\/\/doi.org\/10.3944\/AOTT.2012.2632.","journal-title":"Acta Orthop Traumatol Turc"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-024-02394-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-024-02394-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-024-02394-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T10:02:30Z","timestamp":1714039350000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/s12893-024-02394-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,25]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["2394"],"URL":"https:\/\/doi.org\/10.1186\/s12893-024-02394-3","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,25]]},"assertion":[{"value":"13 August 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 April 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The local institutional review board approved the patient record review and collection of all data (reference number: Chonnam National University Hospital-2020-374). For this type of study, formal informed consent was not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"125"}}