Background: Terrible triad injuries are devastating clinical entities with different approaches described in the literature for fixation.Stability and an ideal range of motion are paramount for a favorable clinical outcome. The purpose of the study was to review the current protocols and surgical management of this complex injury and to assess the stability and range of motion of eight cases reported.Methods: Case series of patients involved in a non-salvageable radial head fracture. After surgery, the follow-up period was 27 months. The primary outcome measures were a range of motion and elbow stability intra-operatively and postoperatively. Secondary outcome measures were Mayo elbow performance scores.Results: Seven patients were included in the study, with a total of eight elbows presented with a terrible triad in our institute between February 2020 and May 2022. All cases reached the desired stability following coronoid repair, radial head replacement, and lateral ulnar collateral ligament repair (LUCL). Range of motion got 10 to 125 degrees on the twelfth week postoperatively. Mayo elbow performance and Disabilities of the Arm, Shoulder, and Hand Questionnaire scores were favorable at the final follow-up, with no chronic instability in all cases. Conclusion:Single incision using the Kocher approach, coronoid-first fixation using anchor suture is feasible following the removal of a comminuted radial head, followed by radial head replacement and LUCL repair resulting in desirable clinical outcomes. There is no superior current protocol for treating these injuries.
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