Terrible triad repair is an operation to address the three components of a complex elbow injury: elbow dislocation, radial head fracture, and coronoid fracture. This injury pattern creates significant instability and requires systematic surgical reconstruction.
Through one or two incisions around the elbow, each component is addressed systematically. The coronoid fracture is fixed with screws or sutures. The radial head is fixed with a plate or, if shattered, replaced with a metal prosthesis. The lateral collateral ligament complex is repaired with sutures or suture anchors. The medial collateral ligament may also be repaired if instability persists. The operation takes two to three hours.
The terrible triad is inherently unstable — without surgery, the elbow redislocates and develops severe stiffness and arthritis. Systematic repair of all three components is essential.
Not appropriate for complete terrible triad injuries. Simple elbow dislocations without fracture can often be managed with brief immobilisation and physiotherapy.
CT scan is essential to assess both fractures. Surgery within one to two weeks of injury.
Restoration of a stable, concentrically reduced elbow allowing early movement. Most patients achieve a functional arc of motion, though some permanent stiffness is common.
Very common. Some loss of full extension is expected.
Unwanted bone formation. Preventive measures may be used.
Numbness in the ring and little fingers.
Despite repair, the elbow may remain unstable requiring further surgery.
Articular cartilage damage from the original injury.
Radial head prosthesis loosening or dislocation.
Deep infection.
General anaesthesia with regional arm block.
A hinged elbow brace allowing controlled movement. Early supervised physiotherapy is critical — the elbow stiffens rapidly. Active movement from one to two weeks. Strengthening from six to eight weeks. Full recovery six to twelve months.
Frequent early reviews. X-rays at two weeks, six weeks, and three months.
The combination of dislocation, radial head fracture, and coronoid fracture was historically associated with poor outcomes. Modern systematic surgical repair has significantly improved results, but the name persists.
Most patients achieve a functional arc (approximately 30–130 degrees) sufficient for daily activities. Some permanent loss of terminal extension is common but rarely functionally significant.