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Coronoid fixation, LUCL reconstruction, radial head replacement
28%
442/1603
Coronoid fixation, LUCL repair to the ulna, radial head replacement
13%
203/1603
Coronoid fixation, LUCL repair to the humerus, radial head replacement
55%
886/1603
LUCL reconstruction and radial head replacement only
3%
50/1603
Total elbow arthroplasty
0%
2/1603
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This patient has a terrible triad injury of the elbow. Coronoid fixation, radial head replacement, and LUCL repair (most commonly to the humerus) would be the most appropriate surgical intervention for this patient.Terrible triad injury of the elbow is a traumatic injury pattern of the elbow characterized by elbow dislocation, radial head/neck fracture, and a coronoid fracture. Diagnosis can be made with plain radiographs of the elbow. CT studies are helpful for surgical planning. Treatment is generally ORIF versus radial head arthroplasty, LCL repair, coronoid ORIF, and possible MCL reconstruction.Gupta et al. reviewed surgically treated terrible triad injuries to determine early dislocation rate, range of motion, frequency and types of secondary surgical interventions, and the frequency of heterotopic ossification and patient-reported stiffness. They reported that only one of the 52 patients sustained a dislocation within the first weeks after surgery. They noted that stiffness remains a challenge in these patients. They concluded that many patients who initially do not attain a functional range of motion can usually attain this after secondary procedures aimed at removing the heterotopic ossification.McKee et al. reported on their standard surgical protocol for terrible triad injuries. They postulated that early intervention, stable fixation, and repair would provide sufficient stability to allow motion at seven to ten days postoperatively and enhance functional outcomes. They concluded that the use of this surgical protocol for terrible triad injuries restored sufficient elbow stability to allow early motion postoperatively, enhancing the functional outcome. Figures A-C are the radiographs of an elbow that demonstrate a terrible triad injuryIncorrect Answers:Answers 1 & 4: In the acute injury, a repair is favored over a reconstruction as the LUCL is most commonly avulsed off the humeral originAnswer 2: The LUCL most commonly avulses off the humeral originAnswer 5: A total elbow arthroplasty would not be indicated in a 42-year-old male with a terrible triad injury. Attempts should be made at osseous and ligamentous stabilization
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