Komplexes Ellenbogentrauma: Therapie und Zugangswahl bei Terrible-triad-Verletzungen und Monteggia-like-Läsionen

The combination of a humeroulnar dislocation of the elbow joint with disruption of parts of the capsuloligamentous structures along with an associated radial head and coronoid fracture is defined as a terrible triad injury. The term “Monteggia-like lesion” or “Monteggia-equivalent injury” encompasses fractures of the proximal ulna with dislocation and fracture of the radial head. Both injuries pose a particular challenge in treatment due to their specific and complex injury patterns. Incorrectly assessed instabilities of the elbow joint can lead to chronic dislocation and subluxation of the elbow, resulting in persistent pain, osteoarthritis, and poor functional outcomes. Selected fracture dislocations without instability of the elbow joint can be treated conservatively, but most fracture types require surgery. The aim of surgical therapy in managing these fracture patterns is restoration of the stability of the elbow joint. This can require reconstruction of the bony and ligamentous as well as muscular stabilizers of the elbow joint. This article discusses the important osseous and soft tissue stabilizers of the elbow joint and provides management protocols for the different injury patterns of the terrible triad injury and Monteggia-like lesions, and puts them into an up-to-date scientific context.