This 2006 JAAOS review covers the anatomy, classification, and surgical management of complex elbow instability — defined as ulnohumeral dislocation combined with fracture of the radial head, coronoid, olecranon, or distal humerus. It synthesizes available evidence on how to approach each injury pattern, from isolated radial head fractures to terrible triad injuries, posterior Monteggia lesions, and transolecranon fracture-dislocations.
When you see a posterolateral elbow dislocation with radial head and coronoid fractures (terrible triad), do not excise the radial head — fix or replace it with metal, fix the coronoid, and repair the LCL; addressing all three is what separates an 82% satisfactory outcome from a 50% redislocation rate.
If instability persists after bony and ligamentous repair, a hinged external fixator centered on the axis of the capitellum is your next move.
This 2006 JAAOS review covers the anatomy, classification, and surgical management of complex elbow instability — defined as ulnohumeral dislocation combined with fracture of the radial head, coronoid, olecranon, or distal humerus. It synthesizes available evidence on how to approach each injury pattern, from isolated radial head fractures to terrible triad injuries, posterior Monteggia lesions, and transolecranon fracture-dislocations.
When you see a posterolateral elbow dislocation with radial head and coronoid fractures (terrible triad), do not excise the radial head — fix or replace it with metal, fix the coronoid, and repair the LCL; addressing all three is what separates an 82% satisfactory outcome from a 50% redislocation rate.
If instability persists after bony and ligamentous repair, a hinged external fixator centered on the axis of the capitellum is your next move.