The effect of radiological and functional results of patients on daily activities after terrible triple surgery for elbow dislocations

Introduction: The terrible triad of the elbow; elbow dislocation is a serious injury with a high potential for complications associated with radial head fracture and coronoid fracture. Successful surgical treatment affects clinical and functional outcomes. In this study, we aim to investigate the effect of scoring inventories that evaluate the radiological findings and elbow functions on the daily activities of patients by measuring the ulnohumeral opening angle after surgery for the first time in the literature in terrible triad injuries of the elbow. Materials and method: Twenty-five patients over the age of 18 who were admitted to our clinic between 2015 and 2022 due to a terrible triad injury of the elbow and treated surgically and after at least one year after the treatment were included. Radial neck-body angle (RBGA), ulnohumeral opening angle (UHAA) and olecranon-coronoid angle (OKA) measurements from the last elbow radiographs of the patients were evaluated radiologically. Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), Mayo Clinic Elbow Performance Score (MEPS), Oxford Elbow Score (OES), Short Form-36 (SF-36), Visual Analog Scale (VAS), Chedoke Arm and Hand Activity Inventory-13 (CAHAI-13) and Patient-Based Forearm Assessment Questionnaire (HBÖKDA) were used for functional evaluation of patients. The data of the operated upper extremity and the unoperated upper extremity data were compared. Results: The mean age of 25 patients included in the study was 48 (min:23, max:80). Elbow injuries were caused by a simple fall in 7 (28%) patients, a fall from a ladder in 7 (28%) patients, a fall from a height in 5 (20%) patients, a fall from a tree in 4 (16%) patients, and a fall from a car in 2 (8%) patients. According to the Regan-Morrey Classification, 13 (52%) patients were classified as Type I, 11 (44%) as Type II, and 1 (4%) as type III. According to the Mason Classification, 10 (40%) patients vii were classified as Type I, 8 (32%) as Type II and 7 (28%) as Type III. When the joint range of motion was compared between the two groups, a statistically significant difference was observed (p<0.05). When RBGA and OKA values were compared between the two groups, a statistically significant difference was observed (p<0.05). When UHAA values were compared between the two groups, no statistically significant difference was found (p>0.05). When functional evaluations were compared between the two groups, a statistically significant difference was observed (p<0.05). A weak correlation was found between RGBA values and Quick DASH, VAS, HBÖKDA, MEPS, OES and CAHAI-13 (p>0,05). A weak correlation was found between UHAA values and Quick DASH, VAS and HBÖKDA (p>0,05). Moderate correlation was found between UHAA values and MEPS, OES, and CAHAI -13 (p<0,05). A weak correlation was found between OKA values and MEPS, OES, CAHAI -13, Quick DASH, VAS and HBÖKDA (p>0,05). Conclusion: After the terrible triad surgery of the elbow, the parameter with the strongest correlation with daily activities was the degree of flexion. In our study, when the correlation between CAHAI-13 and HBÖKDA, which was used for the first time in follow-ups after elbow surgery, and MEPS and Quick DASH, which are frequently used in the literature, was found to be strong (p<0,01). We predict that these strong correlation can be used in CHAAI-13 and HBÖKDA follow-ups after elbow surgery however, further research is needed.