This JAAOS review article examines the terrible triad injury — elbow dislocation combined with radial head and coronoid process fractures — covering relevant anatomy, biomechanics, fracture classification systems, surgical decision-making, and rehabilitation principles. It synthesizes available clinical outcome data to answer how these injuries should be systematically managed to maximize elbow stability and early motion.
When you see an elbow dislocation with radial head and coronoid fractures on imaging, operate with a lateral-first systematic algorithm — fix the coronoid through the radial head defect, repair or replace the radial head, then repair the LCL; reserve MCL repair for persistent instability beyond ~30° of extension.
Prioritize stable enough fixation to start motion within 2–5 days, because delayed mobilization and prolonged immobilization are the most consistent predictors of a poor functional result.
This JAAOS review article examines the terrible triad injury — elbow dislocation combined with radial head and coronoid process fractures — covering relevant anatomy, biomechanics, fracture classification systems, surgical decision-making, and rehabilitation principles. It synthesizes available clinical outcome data to answer how these injuries should be systematically managed to maximize elbow stability and early motion.
When you see an elbow dislocation with radial head and coronoid fractures on imaging, operate with a lateral-first systematic algorithm — fix the coronoid through the radial head defect, repair or replace the radial head, then repair the LCL; reserve MCL repair for persistent instability beyond ~30° of extension.
Prioritize stable enough fixation to start motion within 2–5 days, because delayed mobilization and prolonged immobilization are the most consistent predictors of a poor functional result.