A Review of Terrible Triad Injury of the Elbow

Abstract

Posterior dislocation of the elbow with fractures of the radial head and coronoid process is known as the “terrible triad” because of inherent difficulty in treatment and high rate of complications. An extensive search of the recent literature was conducted and identified articles were reviewed. The treatment modalities for terrible triad injury were then analyzed on the basis of the functional outcomes resulting from each technique. Measurements of outcomes included elbow flexion-extension arc, forearm rotation arc, and Mayo elbow performance index. In total, the current review reports on 21 studies over the last 10 years in which there were patients with elbow dislocation, fracture of the coronoid process and radial head, treatment specific to those patients was described, and a validated form of patient assessment was used to measure outcomes at follow-up. It was found that the most common method of treatment is prosthetic replacement of the radial head, coronoid fixation by transosseous suture, and repair of the lateral collateral ligament complex. The literature suggests that range of motion and Mayo elbow performance index scores are highest for patients treated early with either radial head prosthesis or open reduction and internal fixation, and transosseous suture of the coronoid. Level of Evidence: The present study is a review of level III and IV studies investigating the results of treatment modalities for terrible triad injuries.