Objective To discuss the diagnosis and surgical treatment of the terrible triad of the elbow. Methods Twenty-seven patients with the terrible triad of the elbow were retrospectively evaluated. There were 8 females and 19 males, with an average age of 38 years (range, 14-72 years). Twenty-three patients were treated with a single Koeher approach, 3 with a lateral approach combined with a medial approach and 1 with posterior median approach. All patients were followed up for clinical examination, functional evaluation and radiographs. They were evaluated with Mayo Elbow Performance Score (MEPS) and system of Broberg & Morrey. The radiographs of the last follow-up were evaluated with the Broberg & Money gradations of roentgenographic evidence of degenerative arthritis at the elbow. The grip strength difference between the dominant and non-dominant arms was normalized for comparison according to Money's study. Results No patient complained pain at a mean follow-up of 17.5 months (range, 6-33 months). They had an average of 126° (range, 80° to 150°) of flexion of the elbow and 19° (range, 0° to 70°) to full extension. The average ulnohumeral motion was 107° (range, 30° to 150°). The average motion of forearm rotation was 147° (range, 0° to 220°). The average MEPS was 93.4 points (range, 72 to 100 points). The average functional rating index of system of Broberg & Morrey was 91.2 points (range, 68 to 100 points). Conclusion The diagnosis of the terrible triad of the elbow requires careful differentiation from other elbow injuries. Most operations of the terrible triad of the elbow can be accomplished with a single Kocher approach. With operative treatment, the surgeon should attempt to restore the reduction and stability of the elbow, preserve the radial head when possible and try to perform internal fixation of coronoid fracture. It is important to repair soft tissue injury. Key words: Elbow joint; Dislocations; Ulna fractures; Radius fractures