Trans-ulnar fracture dislocations of the elbow: a systematic review and clarification of classification systems.

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Abstract

[Indexed for MEDLINE] 2. Orthop Traumatol Surg Res. 2025 Apr;111(2):103900. doi: 10.1016/j.otsr.2024.103900. Epub 2024 May 3. Biomechanical evaluation of the modified lasso technique. Rider S(1), Caldwell C(1), Chauvin B(1), Barton RS(1), Perry K(1), Solitro GF(2). Author information: (1)Biomechanical Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health, 1501 Kings Hwy, Shreveport, LA 71103, United States. (2)Biomechanical Laboratory, Department of Orthopaedic Surgery, Louisiana State University Health, 1501 Kings Hwy, Shreveport, LA 71103, United States. Electronic address: giovanni.solitro@lsuhs.edu. BACKGROUND: The Terrible Triad of the elbow is a constellation of elbow dislocation, radial head fracture and coronoid process fracture. A common type of coronoid fracture documented with this triad is type II Regan-Morrey coronoid fractures. The preferred fixation method for this fracture type is the lasso technique, medial-lateral tunnel orientation being the traditional approach. Considering elbow anatomy, we saw an opportunity to potentially improve fixation by altering the suture lasso tunnel orientation to a proximal-distal orientation. HYPOTHESIS: Two tunnels in the proximal-distal direction would result in greater biomechanical stability as compared to the traditional lasso technique. MATERIAL AND METHODS: A type 2 Regan-Morrey fracture was created in 12 fresh frozen cadaveric elbows at 50% of the coronoid height using an oscillating saw. The humero-ulnar joint was placed in 0 degrees flexion then loaded at a rate of 10mm/min to failure. RESULTS: The control technique (medio-lateral tunnels) showed failure load of 150±81N that was not significantly different (p=0.825) than the 134±116N measured for the modified technique (distal-proximal tunnels). The portion of the load-displacement curve used to calculate stiffness was linear (R^2=0.94±0.04) with determination coefficients that did not differ between the two groups (p=0.351). For stiffness, we measured 17±13N/mm and 14±12N/mm respectively for control and modified techniques that did not result in a significant difference (p=0.674). CONCLUSION: In this attempt to improve the shortcomings of the lasso technique, we found that changing from medio-lateral to proximal-distal drilling directions did not result in an appreciable biomechanical benefit. LEVEL OF EVIDENCE: Basic science study; Biomechanics. Copyright © 2024 Elsevier Masson SAS. All rights reserved. DOI: 10.1016/j.otsr.2024.103900