Right shoulder and arm, posterior view

Posterior view of right elbow

Blood supply and anastomosis around the right elbow. Anterior view

The triangular structure of distal humerus at elbow joint provides structural strength.

The terrible triad elbow injury is a traumatic elbow injury characterized by elbow dislocation, radial head/neck fracture and a coronoid fracture.

Mechanism: fall on extended arm with an axial, valgus and posterolateral complex disruption producing a posterolateral elbow dislocation.

Coronoid fixation options include:

• Suture, suture anchor fixation
• Lag screws
• Plate fixation (rare)

• Lateral approach (Kocher/Kaplan)
• Surgery considerations for radial head/neck injury associated with Terrible Triad. ORIF coronoid and lateral elbow ligament complex.

• LCL repaired and sutured to lateral epicondyle through bone tunnels or anchor fixation
• With elbow at 90° flexion the LCL is repaired with forearm in pronation if MCL is intact or forearm in supination if torn MCL

Coronoid fixation options include:

• Suture, suture anchor fixation
• Lage screws
• Plate fixation (rare)

Approach: Through site of radial head/neck fracture or lateral approach. Medial approach additional option. A medial over-the-top, Taylor and Scham or FCU split approach may be used.

Fracture reduction and screw fixation for large fracture fragments. Type fractures may require a Lasso technique by suture fixation of Brachialis muscle/tendon complex  and securing it by tie fixation after passing it  to through olecranon bone tunnels.

Hinged external fixator can supplement unstable elbow fracture ORIF and ligament repair.

• Immobilization in arm splint 3-4 weeks: maintain hand gripping exercises
• After fracture healing with radiologically callous formation gravity eliminated exercises are performed
• No load bearing exercises until fracture union

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