Ring et al. report outcomes in 11 patients with the "terrible triad of the elbow" — posterior dislocation combined with radial head and coronoid fractures — treated at two level-I trauma centers and followed for a minimum of two years, asking what treatment strategies lead to acceptable outcomes in this notoriously unstable injury.
When you see a posterior elbow dislocation with both a radial head fracture and a coronoid fracture, recognize this as a terrible triad: it will almost certainly redislocate in a splint and cannot tolerate radial head resection.
The operative goal is restoring radiocapitellar contact (fix or replace the radial head), repairing the lateral collateral ligament, and strongly considering coronoid fixation — use CT if you're unsure whether the coronoid is involved.
Ring et al. report outcomes in 11 patients with the "terrible triad of the elbow" — posterior dislocation combined with radial head and coronoid fractures — treated at two level-I trauma centers and followed for a minimum of two years, asking what treatment strategies lead to acceptable outcomes in this notoriously unstable injury.
When you see a posterior elbow dislocation with both a radial head fracture and a coronoid fracture, recognize this as a terrible triad: it will almost certainly redislocate in a splint and cannot tolerate radial head resection.
The operative goal is restoring radiocapitellar contact (fix or replace the radial head), repairing the lateral collateral ligament, and strongly considering coronoid fixation — use CT if you're unsure whether the coronoid is involved.