Prospective case series of 32 patients with terrible triad elbow injuries managed at three tertiary centers. Describes a systematic surgical algorithm combining coronoid-brachialis complex repair, radial head reconstruction or replacement, collateral ligament repair, and selective hinged external fixation — asking whether this protocol reliably achieves functional stability.
When you encounter a terrible triad injury, address all three elements — coronoid-brachialis complex, radial head, and both collateral ligaments. Even when the coronoid fragment is tiny and unreconstructable; repairing the soft-tissue sleeve is as important as bony fixation.
If the construct remains unstable after ligament and radial head repair, add a hinged external fixator rather than immobilizing the elbow, as early protected motion drives better functional recovery.
Prospective case series of 32 patients with terrible triad elbow injuries managed at three tertiary centers. Describes a systematic surgical algorithm combining coronoid-brachialis complex repair, radial head reconstruction or replacement, collateral ligament repair, and selective hinged external fixation — asking whether this protocol reliably achieves functional stability.
When you encounter a terrible triad injury, address all three elements — coronoid-brachialis complex, radial head, and both collateral ligaments. Even when the coronoid fragment is tiny and unreconstructable; repairing the soft-tissue sleeve is as important as bony fixation.
If the construct remains unstable after ligament and radial head repair, add a hinged external fixator rather than immobilizing the elbow, as early protected motion drives better functional recovery.