• Fabian Lanzerath, Jutta Knifka, Tim Leschinger, Nadine Ott, Stephanie Kahmann, Michael Hackl, Lars P Müller, and Kilian Wegmann.
• Department of Orthopedic and Trauma Surgery, University Hospital Cologne, Kerpener Street 62, 50937, Cologne, Germany. fabian.lanzerath1@uk-koeln.de.
• Arch Orthop Trauma Surg. 2023 Jul 1; 143 (7): 422942374229-4237.

IntroductionThe 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 MethodsTo 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.ResultsThe 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%).ConclusionsThe 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.© 2022. The Author(s).

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