The simulation of terrible triad injuries in fresh-frozen human cadaveric specimens with intact soft tissue envelope

Arch Orthop Trauma Surg. 2023 Jul;143(7):4229-4237. doi: 10.1007/s00402-022-04677-x. Epub 2022 Dec 13.


Introduction: The aim of the present study was to develop a technical process to reproducibly generate terrible triad injuries (TTI) in fresh-frozen human cadaveric specimens, while leaving the skin intact. Such "pre-fractured" specimens, used for scientific analysis and for surgical education, might help to improve current treatment, which is complex and prone to complications.

Materials and methods: To induce the desired fractures, a custom-made fracturing unit was used to apply an axial force on the extended cadaveric elbow specimens, with the forearm pronated and under valgus load. To simulate the valgus load, a pneumatic cylinder was developed to apply valgus stress to the joint by an additional force vector from the lateral side of the joint.

Results: The success rate of TTI induction was 92.3% (12/13). Of the 12 radial head fractures, 3 (25%) were classified Mason type II and 9 (75%) Mason type III. The coronoid fractures were grouped in tip subtype 2 (5 fractures, 41.7%), anteromedial facet (AMF) subtype 2 (4 fractures, 33.3%), AMF subtype 3 (1 fracture, 8.3%) and basal subtype 1 (2 fractures, 16.7%).

Conclusions: The present study provides an instrument for successful and reproducible production of dislocation fracture patterns with their typical accompanying soft tissue lesions. The methodology might be applied on a broad basis to be able to perform biomechanical studies regarding primary stability of fixation concepts for TTI and to educate surgeons in a fairly realistic scenario with the surgical treatment of TTI.

Keywords: Elbow; Fracture simulation; Fresh-frozen cadaveric specimens; Intact soft tissue; Surgical education; Terrible triad injury.

MeSH terms

  • Cadaver
  • Elbow Injuries*
  • Elbow Joint* / surgery
  • Humans
  • Joint Dislocations* / surgery
  • Radius Fractures* / surgery
  • Ulna Fractures* / surgery