Terrible triad injury of the elbow (TTE) is a complex dislocation of the elbow caused by severe violent impact. The elbow is usually in a straight state when the patient is injured, and the impact force is transmitted to the elbow along the longitudinal axis of the forearm and is often accompanied by large shear force. Young people who are involved in car accidents or crashes are the main demographic for TTE. It is mainly characterized by posterior dislocation of the elbow joint with fractures of the coronoid process of the ulna and the head of the radius. TTE is mainly caused by compression and shear force exerted on the longitudinal axis of the extended upper limb. Currently, TTE is mainly treated by surgery in order to restore elbow joint function and improve prognosis. Currently, the mainstream surgical approaches for TTE include medial approach, lateral approach and combined internal and external approach. The selection of reasonable approach and internal fixation can effectively reduce postoperative elbow pain, stiffness, ectopic ossification, traumatic arthritis and other complications, and have certain positive effects on the recovery of elbow joint function of patients, thus improving the quality of life of patients.

To compare the intraoperative indexes and postoperative efficacy of the combined internal and lateral approach and the single lateral approach in the treatment of TTE.

According to the search strategy, the literature published in Embase, Pubmed, Cochrane Library, Cinahl, WanfangData, CNKI and other databases on the treatment of elbow terror triad by combined internal-lateral approach and lateral approach was searched respectively. A total of 679 relevant literatures were retrieved, and 13 literatures were finally included. The literature quality was evaluated according to Cochrane systematic Review methodology, and the extracted data was used for meta-analysis using Review manager 5.4 software.

In the treatment of elbow terror triad, the operative time and intraoperative blood loss of the combined internal-lateral approach were higher than those of the lateral approach, and the differences were statistically significant [95% CI (5.43, 34.01), P=0.007][95% CI (5.57, 23.46), P=0.001]. However, the results of the comparison showed that the postoperative joint motion of the combined internal-lateral approach was higher than that of the lateral approach [95% CI (9.16,19.25), P<0.01]. In addition, there were no significant differences in VAS score, MEPS score, excellent rate and complications between the two groups.

In the treatment of TTE, the lateral approach has the advantages of short operation time and less blood loss, but the elbow joint motion after the combined internal and lateral approach is better. Therefore, the choice of the two surgical approaches needs to be analyzed according to the specific conditions of the disease.