A Case Series of Terrible Triad Elbow Injuries Treated with Lasso Suture Fixation for Coronoid, Tripod Fixation for Radial Head, and LCL Repair.

Introduction: Terrible triad includes posterior dislocation of the elbow, radial head fracture, and coronoid fracture. It renders the elbow joint unstable, creating a need for surgical intervention. The purpose of our study was to analyze the outcomes in such patients who underwent surgery in this tertiary care center.

Case report: Ten cases were identified in this monocentric single surgeon retrospective study. The cases had radial head tripod fixation with Headless screws, coronoid fixation with transosseous suture tape, and lateral collateral ligament (LCL) repair with suture anchors/ethibond. The assessment was done using the Oxford elbow score and range of motion.

Results: Eight of the ten cases had Mason type 3 radial head fracture pattern, and the remaining had type 2. Six cases had Regan Morey type 1 coronoid fracture, rest had type 2. The mean follow-up period was 38 months (range 4-64 months). The Oxford elbow scores for Pain: A mean of 98.6 (standard deviation [SD] 3.1), Function: A mean of 97.8 (SD 3.6), and Psychosocial domain: A mean of 96 (SD 5.8). The flexion-extension range of motion arc mean is 130° (SD 6.1). The mean Pronation is 69° (SD 2.23). The mean supination is 79° (SD 2.23). Heterotopic ossification was noticed in one patient.

Conclusion: A radial head fracture with three or more fragments should not always indicate a radial head prosthesis or excision. Fixation can also achieve good results. LCL repair, coronoid fixation, and the anterior capsule add to joint stability.