[ORT-L] timing of surgery for 'terrible triad' elbow fx-disloc


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[ORT-L] timing of surgery for 'terrible triad' elbow fx-disloc

jjbrooksmd at gmail
New User

Oct 6, 2007, 6:12 PM

Post #1 of 5 (714 views)
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[ORT-L] timing of surgery for 'terrible triad' elbow fx-disloc	Can't Post

Dear List Members,

Does anyone know of a reference (or maybe meeting presentation)
suggesting optimal timing for ORIF of 'terrible triad' elbow fracture-
dislocations?

I remember hearing over & over again that surgical delay is a bad
idea and that these need to be fixed as soon as patient condition
permits otherwise the incidence of complications such as stifffness &
heterotopic ossification increase. I just can't quickly find the
reference(s) supporting the push for urgency.

Also, should there be a delay, is H.O. prophylaxis like single-dose
radiation or NSAID advisable?

Thanks very much,

Jeff Brooks
Stamford, CT

Jeffrey J Brooks, MD
Hand & Upper Extremity Surgery
Orthopaedic Trauma Surgery

Orthopaedic Surgery & Sports medicine center
1290 Summer Street, #4400
Stamford, CT 06905
(203) 323-7331

The information contained in this electronic mail transmittal may
contain healthcare information and is protected by law. This message
is intended only for the use of the designated recipient(s) named
above. If the reader of this transmission is not the intended
recipient(s), you are notified that any disclosure, dissemination,
distribution or duplication of its contents is strictly prohibited.
If you have received this transmittal in error, please notify the
sender by return e-mail and delete the transmittal immediately. Thank
you.

samsonov.shen at gmail
New User

Oct 7, 2007, 3:03 AM

Post #2 of 5 (709 views)
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Re: [ORT-L] timing of surgery for 'terrible triad' elbow fx-disloc [In reply to]	Can't Post

I recommand the fixation should be asap. Delay fixation will bring trouble
to both patient and us.

On 10/7/07, Jeff Brooks <jjbrooksmd@gmail.com> wrote:
>
> Dear List Members,
>
>
> Does anyone know of a reference (or maybe meeting presentation) suggesting
> optimal timing for ORIF of 'terrible triad' elbow fracture-dislocations?
>
>
> I remember hearing over & over again that surgical delay is a bad idea and
> that these need to be fixed as soon as patient condition permits otherwise
> the incidence of complications such as stifffness & heterotopic ossification
> increase. I just can't quickly find the reference(s) supporting the push for
> urgency.
>
>
> Also, should there be a delay, is H.O. prophylaxis like single-dose
> radiation or NSAID advisable?
>
>
> Thanks very much,
>
>
> Jeff Brooks
> Stamford, CT
>
>
> Jeffrey J Brooks, MD
> Hand & Upper Extremity Surgery
> Orthopaedic Trauma Surgery
>
> Orthopaedic Surgery & Sports medicine center
> 1290 Summer Street, #4400
> Stamford, CT 06905
> (203) 323-7331
>
>
> The information contained in this electronic mail transmittal may contain
> healthcare information and is protected by law. This message is intended
> only for the use of the designated recipient(s) named above. If the reader
> of this transmission is not the intended recipient(s), you are notified that
> any disclosure, dissemination, distribution or duplication of its contents
> is strictly prohibited. If you have received this transmittal in error,
> please notify the sender by return e-mail and delete the transmittal
> immediately. Thank you.
>
>
>
>
>
>
>
>

--
Dr. Sam.Shen
Dept. of Othropaedic and Trauma
Xin-hua hospital
Shanghai , P.R. China

mylesclough at shaw
New User

Oct 9, 2007, 12:48 AM

Post #3 of 5 (674 views)
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Re: [ORT-L] timing of surgery for 'terrible triad' elbow fx-disloc [In reply to]	Can't Post

1. A search for "terrible triad" elbow yields 11 results -
http://www.ncbi.nlm.nih.gov/sites/entrez?
Db=pubmed&Cmd=DetailsSearch&Term=%22terrible+triad%22%5BAll+Fields%5D
+AND+(%22elbow%22%5BMeSH+Terms%5D+OR+elbow%5BText+Word%5D)
2. The Toronto group wrote a paper on the subject (JBJS - A 2004).
The "Related Articles" list headed by this paper has a number of
articles. -
http://www.ncbi.nlm.nih.gov/sites/entrez?
Db=pubmed&DbFrom=pubmed&Cmd=Link&LinkName=pubmed_pubmed&LinkReadableName
=Related%
20Articles&IdsFromResult=15173283&ordinalpos=1&itool=EntrezSystem2.PEntr
ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
I haven't gone all through these to see if there is any support for
the commonly given advice to fix them early.
3. MeSH (Medical Subject Headings) has a heading "Time Factors"[MeSH]
If you run a search for that and look at the overlap between this
search (3) and (2) above, there are 146 articles which appear in both
searches. The most promising in a brief look at the first few was one
in German without an abstract! "Time interval between accident and
operation in relation to long-term outcome" Mader Z Orthop Ihre
Grenzgeb. 2007 Jan-Feb;145(1):1-4.
Unfortunately I cannot send you the "overlap" search as it uses
History numbers (ie #2 AND #3) if you use the numbers above. The
history function in PubMed is one of the tabs just under the search box.
Let me know if I can be of any more help.
Myles Clough MD FRCSC
Orthopaedic Surgeon, Retired
Kamloops, BC
mylesclough@shaw.ca
Clinical Instructor, University of British Columbia
Associate Editor, Orthogate www.orthogate.org
Editor, Orthopaedic Web Links (OWL) www.orthopaedicweblinks.com

On 6-Oct-07, at 6:12 PM, Jeff Brooks wrote:

> Dear List Members,
>
> Does anyone know of a reference (or maybe meeting presentation)
> suggesting optimal timing for ORIF of 'terrible triad' elbow
> fracture-dislocations?
>
> I remember hearing over & over again that surgical delay is a bad
> idea and that these need to be fixed as soon as patient condition
> permits otherwise the incidence of complications such as stifffness
> & heterotopic ossification increase. I just can't quickly find the
> reference(s) supporting the push for urgency.
>
> Also, should there be a delay, is H.O. prophylaxis like single-dose
> radiation or NSAID advisable?
>
> Thanks very much,
>
> Jeff Brooks
> Stamford, CT
>
>
> Jeffrey J Brooks, MD
> Hand & Upper Extremity Surgery
> Orthopaedic Trauma Surgery
>
> Orthopaedic Surgery & Sports medicine center
> 1290 Summer Street, #4400
> Stamford, CT 06905
> (203) 323-7331
>
>
> The information contained in this electronic mail transmittal may
> contain healthcare information and is protected by law. This
> message is intended only for the use of the designated recipient(s)
> named above. If the reader of this transmission is not the intended
> recipient(s), you are notified that any disclosure, dissemination,
> distribution or duplication of its contents is strictly prohibited.
> If you have received this transmittal in error, please notify the
> sender by return e-mail and delete the transmittal immediately.
> Thank you.
>
>
>
>

vpmiddha at gmail
New User

Oct 11, 2007, 4:49 AM

Post #4 of 5 (618 views)
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Re: [ORT-L] timing of surgery for 'terrible triad' elbow fx-disloc [In reply to]	Can't Post

Can you cite a good article on "terrible triad"of elbow for an uninitiated
like me?
If possible, can you send a pdf copy, please?

Ved Middha
Gwalior, India

On 10/9/07, Myles Clough <mylesclough@shaw.ca> wrote:
>
> 1. A search for "terrible triad" elbow yields 11 results -
> http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=DetailsSearch&Term=%22terrible+triad%22%5BAll+Fields%5D+AND+(%22elbow%22%5BMeSH+Terms%5D+OR+elbow%5BText+Word%5D)
> 2. The Toronto group wrote a paper on the subject (JBJS - A 2004). The
> "Related Articles" list headed by this paper has a number of articles. -
>
> http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&DbFrom=pubmed&Cmd=Link&LinkName=pubmed_pubmed&LinkReadableName=Related%20Articles&IdsFromResult=15173283&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
> I haven't gone all through these to see if there is any support for the
> commonly given advice to fix them early.
> 3. MeSH (Medical Subject Headings) has a heading "Time Factors"[MeSH] If
> you run a search for that and look at the overlap between this search (3)
> and (2) above, there are 146 articles which appear in both searches. The
> most promising in a brief look at the first few was one in German without an
> abstract! "Time interval between accident and operation in relation to
> long-term outcome" Mader Z Orthop Ihre Grenzgeb. 2007 Jan-Feb;145(1):1-4.
> Unfortunately I cannot send you the "overlap" search as it uses History
> numbers (ie #2 AND #3) if you use the numbers above. The history function in
> PubMed is one of the tabs just under the search box.
> Let me know if I can be of any more help.
> Myles Clough MD FRCSC
> Orthopaedic Surgeon, Retired
> Kamloops, BC
> mylesclough@shaw.ca
> Clinical Instructor, University of British Columbia
> Associate Editor, Orthogate www.orthogate.org
> Editor, Orthopaedic Web Links (OWL) www.orthopaedicweblinks.com
>
>
>
>
>
>
> On 6-Oct-07, at 6:12 PM, Jeff Brooks wrote:
>
> Dear List Members,
>
>
> Does anyone know of a reference (or maybe meeting presentation) suggesting
> optimal timing for ORIF of 'terrible triad' elbow fracture-dislocations?
>
>
> I remember hearing over & over again that surgical delay is a bad idea and
> that these need to be fixed as soon as patient condition permits otherwise
> the incidence of complications such as stifffness & heterotopic ossification
> increase. I just can't quickly find the reference(s) supporting the push for
> urgency.
>
>
> Also, should there be a delay, is H.O. prophylaxis like single-dose
> radiation or NSAID advisable?
>
>
> Thanks very much,
>
>
> Jeff Brooks
> Stamford, CT
>
>
> Jeffrey J Brooks, MD
> Hand & Upper Extremity Surgery
> Orthopaedic Trauma Surgery
>
> Orthopaedic Surgery & Sports medicine center
> 1290 Summer Street, #4400
> Stamford, CT 06905
> (203) 323-7331
>
>
> The information contained in this electronic mail transmittal may contain
> healthcare information and is protected by law. This message is intended
> only for the use of the designated recipient(s) named above. If the reader
> of this transmission is not the intended recipient(s), you are notified that
> any disclosure, dissemination, distribution or duplication of its contents
> is strictly prohibited. If you have received this transmittal in error,
> please notify the sender by return e-mail and delete the transmittal
> immediately. Thank you.
>
>
>
>
>
>
>
>

--
Dr. V.P. Middha
Consultant Orthopaedic Surgeon
Gwalior, India

jjbrooksmd at gmail
New User

Oct 11, 2007, 10:03 AM

Post #5 of 5 (615 views)
Shortcut

Re: [ORT-L] timing of surgery for 'terrible triad' elbow fx-disloc [In reply to]	Can't Post

here you go, 2 good ones,

Jeff

On Oct 11, 2007, at 7:49 AM, Ved Middha wrote:

> Can you cite a good article on "terrible triad"of elbow for an
> uninitiated like me?
> If possible, can you send a pdf copy, please?
>
> Ved Middha
> Gwalior, India
>
>
> On 10/9/07, Myles Clough <mylesclough@shaw.ca> wrote:
> 1. A search for "terrible triad" elbow yields 11 results -
> http://www.ncbi.nlm.nih.gov/sites/entrez?
> Db=pubmed&Cmd=DetailsSearch&Term=%22terrible+triad%22%5BAll+Fields%
> 5D+AND+(%22elbow%22%5BMeSH+Terms%5D+OR+elbow%5BText+Word%5D)
> 2. The Toronto group wrote a paper on the subject (JBJS - A 2004).
> The "Related Articles" list headed by this paper has a number of
> articles. -
> http://www.ncbi.nlm.nih.gov/sites/entrez?
> Db=pubmed&DbFrom=pubmed&Cmd=Link&LinkName=pubmed_pubmed&LinkReadableNa
> me=Related%
> 20Articles&IdsFromResult=15173283&ordinalpos=1&itool=EntrezSystem2.PEn
> trez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
> I haven't gone all through these to see if there is any support for
> the commonly given advice to fix them early.
> 3. MeSH (Medical Subject Headings) has a heading "Time
> Factors"[MeSH] If you run a search for that and look at the overlap
> between this search (3) and (2) above, there are 146 articles which
> appear in both searches. The most promising in a brief look at the
> first few was one in German without an abstract! "Time interval
> between accident and operation in relation to long-term outcome"
> Mader Z Orthop Ihre Grenzgeb. 2007 Jan-Feb;145(1):1-4.
> Unfortunately I cannot send you the "overlap" search as it uses
> History numbers (ie #2 AND #3) if you use the numbers above. The
> history function in PubMed is one of the tabs just under the search
> box.
> Let me know if I can be of any more help.
> Myles Clough MD FRCSC
> Orthopaedic Surgeon, Retired
> Kamloops, BC
> mylesclough@shaw.ca
> Clinical Instructor, University of British Columbia
> Associate Editor, Orthogate www.orthogate.org
> Editor, Orthopaedic Web Links (OWL) www.orthopaedicweblinks.com
>
>
>
>
>
>
> On 6-Oct-07, at 6:12 PM, Jeff Brooks wrote:
>
>> Dear List Members,
>>
>>
>> Does anyone know of a reference (or maybe meeting presentation)
>> suggesting optimal timing for ORIF of 'terrible triad' elbow
>> fracture-dislocations?
>>
>>
>> I remember hearing over & over again that surgical delay is a bad
>> idea and that these need to be fixed as soon as patient condition
>> permits otherwise the incidence of complications such as
>> stifffness & heterotopic ossification increase. I just can't
>> quickly find the reference(s) supporting the push for urgency.
>>
>>
>> Also, should there be a delay, is H.O. prophylaxis like single-
>> dose radiation or NSAID advisable?
>>
>>
>> Thanks very much,
>>
>>
>> Jeff Brooks
>> Stamford, CT
>>
>>
>> Jeffrey J Brooks, MD
>> Hand & Upper Extremity Surgery
>> Orthopaedic Trauma Surgery
>>
>> Orthopaedic Surgery & Sports medicine center
>> 1290 Summer Street, #4400
>> Stamford, CT 06905
>> (203) 323-7331
>>
>>
>> The information contained in this electronic mail transmittal may
>> contain healthcare information and is protected by law. This
>> message is intended only for the use of the designated recipient
>> (s) named above. If the reader of this transmission is not the
>> intended recipient(s), you are notified that any disclosure,
>> dissemination, distribution or duplication of its contents is
>> strictly prohibited. If you have received this transmittal in
>> error, please notify the sender by return e-mail and delete the
>> transmittal immediately. Thank you.
>>
>>
>>
>>
>>
>>
>
>
>
>
> --
> Dr. V.P. Middha
> Consultant Orthopaedic Surgeon
> Gwalior, India

Jeffrey J Brooks, MD
Hand & Upper Extremity Surgery
Orthopaedic Trauma Surgery

Orthopaedic Surgery & Sports medicine center
1290 Summer Street, #4400
Stamford, CT 06905
(203) 323-7331

The information contained in this electronic mail transmittal may
contain healthcare information and is protected by law. This message
is intended only for the use of the designated recipient(s) named
above. If the reader of this transmission is not the intended
recipient(s), you are notified that any disclosure, dissemination,
distribution or duplication of its contents is strictly prohibited.
If you have received this transmittal in error, please notify the
sender by return e-mail and delete the transmittal immediately. Thank
you.

Attachments:

Posteriordislocationoftheelbowwithfracturesoftheradialheadandcoronoid-RingJupiterJBJS2002.pdf (384 KB)

Standardsurgicalprotocoltotreatelbowdislocationswithradialheadandcoronoidfractures-Pughet.al.JBJS2004.pdf (880 KB)

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