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Suture Lasso Fixation of the Coronoid Process for Elbow Fracture-Dislocations
Grant E. Garrigues, MD1; Walter H. Wray, III, MD1; Anneluuk L.C. Lindenhovius, MD, PhD2; David Ring, MD, PhD2; David S. Ruch, MD1
1 Department of Orthopaedic Surgery, Duke University Medical Center, Boxes 2887 (G.E.G.) and 3466 (D.S.R.), Durham, NC 27710. E-mail address for D.S. Ruch: d.ruch@duke.edu
2 Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02114
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Based on an original article: J Bone Joint Surg Am. 2011 Oct 19;93(20):1873-81.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Essential Surgical Techniques, 2012 Sep 26;2(3):e17 1-10. doi: 10.2106/JBJS.ST.K.00032
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We describe the treatment of terrible triad elbow fracture-dislocation with a systematic approach that includes fixation of the coronoid with the lasso technique.

Step 1: Patient Positioning

Position the patient supine with a tourniquet applied and the arm extended on a hand-table.

Step 2: Surgical Approach

Make the deep lateral exposure through the Kocher interval or through a traumatic posterolateral defect.

Step 3: Coronoid Lasso

Pass a suture over the coronoid fragment and through the anterior aspect of the capsule, drill the ulnar tunnels, pass and tie the sutures.

Step 4: Repair or Replacement of the Radial Head

Using a prosthesis that is too large can lead to overstuffing; choose the minor axis of the radial head to determine the size of the prosthetic radial head.

Step 5: Repair of the Lateral Ulnar Collateral Ligament

Weave heavy, braided suture through the ligament substance or through drill-holes in the ulna.

Step 6: Hanging Arm Test

Extend the elbow over a stack of towels under the upper arm; if the elbow remains stable with the weight of the hanging forearm, no further operative intervention is required.

Step 7: Medial Collateral Ligament (MCL) Repair or External Fixation (Rarely Needed)

In the rare cases in which instability persists, repair the MCL or apply external fixation.

Step 8: Rehabilitation

Tell the patient to strictly avoid abduction of the shoulder so as not to create a varus stress on the lateral ulnar collateral ligament repair.


We recently reported on a retrospective series of forty terrible triad elbow fracture-dislocations14.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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