The aim of this study was to describe the fracture patterns of terrible triad elbow injury (TTEI) and to evaluate complications, functional and radiographic outcomes in mid-term follow-up in patients older than 65 years. A retrospective study of 29 patients, mean follow-up of 48.7±4.6 months (range 65-78). Fractures were classified according to the Mason and Regan-Morrey classifications. All patients were evaluated by the Mayo Elbow Performance Scale (MEPS), Quick-Dash, EQVAS, EQ5D scores, and ROM measurement. The mean age was 72.3 years and 79% were women. Mason Type III (72%) and Reagan-Morrey type II (69%) were the most frequent fracture type. All patients were managed with a lateral approach consisting of repair or replacement of the radial head and repair of the lateral ulnar collateral ligament (LUCL); of these patients, 19 underwent re-attachment of the coronoid process or anterior capsule. Mean functional scores were MEPS 90.3±7.5, Quick-DASH 18.4±4.6, EQ5D .89± 0.33, EQ-VAS 86.2 ± 21, and VAS 2.2± 1.5. Mean postoperative flexo-extension arc of elbow motion was 105º (range, 65º-145º). Two patients (7%) required revision surgery. We did not observe any joint instability in the elbow after surgery. Patients over 65 years old with a terrible triad elbow injury (TTEI) are at substantial risk of complex fracture patterns, particularly Mason type III radial head fractures and Regan-Morrey type II coronoid fractures. Complications such as joint stiffness and heterotopic ossification are infrequent, while associated capitellum fractures are not rare and should be considered in the assessment as they can impact elbow stability. Despite these challenges, surgical management generally achieves favorable functional outcomes with low complication and reoperation rates.

Osteoarthritis (OA) is the most common multifactorial joint disease characterized by progressive cartilage degradation and impaired tissue repair. Osteochondral defects represent a major clinical challenge within OA, as damage to cartilage and underlying bone can initiate degenerative changes and contribute to joint deterioration. The Wnt/β-catenin signaling pathway plays an important role in OA pathogenesis, and its dysregulation contributes to chondrocyte catabolism and cartilage loss. NOTUM, an extracellular Wnt inhibitor, has emerged as a potential therapeutic modulator capable of restoring signaling balance and promoting cartilage homeostasis. This study aimed to evaluate the efficacy of NOTUM compared with hyaluronic acid (HA), human adipose-derived mesenchymal stromal cells (hAd-MSCs), and Colchicine in a rabbit osteochondral defect model relevant to osteoarthritis. Twenty-seven New Zealand White rabbits underwent standardized femoral condyle injury and received single-dose treatments. Serum levels of cartilage biomarkers—Procollagen Type IIA N-terminal Propeptide (PIIANP) and Cartilage Oligomeric Matrix Protein (COMP)—were measured by ELISA at 4, 6, and 8 weeks post-surgery, and histological repair at week 12 was assessed using the modified O’Driscoll scoring system. NOTUM treatment significantly increased PIIANP and decreased COMP levels compared with HA, indicating enhanced cartilage synthesis and reduced degradation. Histological scores confirmed superior surface morphology and tissue composition in NOTUM-treated joints. These findings suggest that NOTUM performs a protective and regenerative effect through Wnt/β-catenin modulation, supporting the conclusion that it enhances osteochondral defect repair and motivating further studies of NOTUM as an OA therapy.