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Nakhaei Amroodi M, Bahaeddini M, Khajeh Alizadeh Attarr M, Hashemipour B, Mahdavifar M, Tabrizian P. Atypical Terrible Triad Injuries of the Elbow Associated With Triceps Tendon Avulsion: A Case Series. JROS 2025; 12 (2) :103-106
URL: http://jros.iums.ac.ir/article-1-2302-en.html

Background: The terrible triad of the elbow classically consists of elbow dislocation, radial head fracture, and coronoid fracture, frequently accompanied by ligamentous injury leading to instability. However, atypical patterns have been increasingly reported, including associated injuries beyond the classical definition.
Case Presentation: We report a case series of four patients presenting with an atypical terrible triad injury of the elbow associated with triceps tendon avulsion. All patients sustained elbow fracture–dislocations following trauma, predominantly due to falling down or car accidents. Surgical management included open reduction and internal fixation (ORIF) with selective repair of osseous and capsuloligamentous structures. All patients achieved elbow stability following surgical intervention. Pain scores, assessed using the visual analog scale (VAS), improved postoperatively, and no cases of recurrent instability were observed during follow-up.
Conclusion: Atypical terrible triad injuries involving triceps tendon avulsion represent a rare but clinically significant variant of elbow fracture–dislocation. Early recognition and comprehensive surgical management are essential to restore elbow stability and function.