Abstract
Stability of the elbow joint is provided primarily by the integrity of the ulno humeral articulation. Secondary contributions to stability are provided by the radio-capitelar joint and the medial collateral ligament complex. Lesser contributions are provided by the lateral ligament and the joint capsule.
A dislocation which is complicated by an injury to one of these main stabilising structures will have a greater risk of instability and recurrent dislocation. Poor outcomes have been noted to occur with both coronoid fractures and significant radial head fractures. There is a group of patients with a more severe injury within this spectrum who have a pattern of injury which leads to gross instability. This “unhappy triad” is a dislocation where there is an associated coronoid fracture, a radial head fracture and complete disruption of the medial collateral ligament complex.
These severe injuries tend to present to a specialist after significant delay with recurrent dislocation following failure of initial management. Three cases will be presented to illustrate the anatomical considerations and management strategies for this pattern of injury by immediate reconstruction, hinged external fixation or elbow replacement.
These abstracts were prepared by Squadron Leader G. Pathak FRCS (Trauma & Orth). Correspondence should be addressed to him at Royal Hospital Haslar, Gosport, Hampshire PO12 2AA.
