Terrible triad of the elbow

Case contributed by Jerry Jiang
Diagnosis certain


Male with a fall down stairs presenting weeks later with persistent limited range of motion, diffuse tenderness, and obvious deformity of the left elbow following casting.

Patient Data

Age: 35 years
Gender: Male

CT Elbow on Presentation


Comminuted fractures of the coronoid process and radial head with posterior subluxation of the ulna. Multiple intraarticular bodies/fracture fragments are seen within the elbow joint. There is marked elbow joint effusion and surrounding soft tissue edema.

The patient was taken to the OR and underwent a left elbow open reduction, radial capsulectomy, radial head arthroplasty, and internal stabilization of the elbow joint by orthopedic surgery.

Intraoperative Portable XR


Status post left radial head arthroplasty and internal fixation of left ulnar olecranon and humeral capitellum. No evidence of subluxation or device loosening. Soft tissue swelling and subcutaneous air are consistent with open reduction. 

FU XR CT reconstruction


Follow up exam done 2 weeks after the ORIF: No evidence of hardware failure or loosening. Some healing at the operative/fracture sites with mild diffuse adjoining heterotopic ossification. Mild diffuse periarticular osteopenia and soft tissue swelling are seen. No elbow joint effusion noted.

Case Discussion

Following a fall-on-outstretched-hand injury, this patient presented with elbow dislocation in addition to fractures of both the radial head and coronoid process, consistent with a terrible triad of the elbow injury. Surgery is the treatment of choice as closed reduction is usually insufficient, as seen in this case. This patient underwent a surgical left elbow open reduction and internal fixation, radial capsulectomy, and radial head arthroplasty. This injury is notoriously difficult to treat as patients often have persistent joint instability, stiffness, or arthrosis. As such, it is fittingly referred to as a terrible triad injury.  


This case was submitted with supervision and input from:

Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center  

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