en جراحی دست / آرنج Hand surgery / Elbow پژوهشی Research Article <strong>Background</strong>: The terrible triad (TT) injury of the elbow, consisting of ulnohumeral dislocation, radial head fracture, and coronoid process fracture, is traditionally managed surgically. However, recent studies have suggested that non-operative management may be a viable option for select patients.&nbsp;<br> <strong>Objectives</strong>: This study evaluates the outcomes of non-operative management in 17 patients with TT injuries treated between 2015 and 2023.<br> <strong>Methods</strong>: A retrospective review was conducted on 17 patients who met specific criteria for non-operative management, including congruent joint reduction, no intra-articular fragments, and a stable range of motion (ROM) up to 45 degrees of extension. Functional outcomes were assessed using the Mayo elbow performance index (MEPI) and the disabilities of the arm, shoulder, and hand (DASH) score. A radiographic evaluation was performed to assess joint congruency and the presence of arthritis.<br> <strong>Results</strong>: The mean follow-up period was 53.24 months (range: 26-96 months). The mean MEPI score was 95.29&plusmn;6.95, and the mean DASH score was 5.64&plusmn;4.06. The mean ROM for the affected elbow was 9.71&plusmn;5.72 degrees in extension, 130.6&plusmn;8.27 degrees in flexion, 65.29&plusmn;10.07 degrees in supination, and 59.71&plusmn;13.4 degrees in pronation. One patient developed ulnar nerve symptoms and underwent ulnar neurolysis and anterior transposition of the medial epicondyle, and two patients reported occasional painful clicking during supination and pronation.<br> <strong>Conclusion</strong>: Non-operative management of TT injuries can yield acceptable functional outcomes in carefully selected patients. However, the potential for reduced supination and pronation, as well as the development of post-traumatic arthritis, should be considered. Further studies with larger cohorts and longer follow-up periods are needed to validate these findings. Terrible triad injury (TT), Elbow dislocation, Radial head fracture, Coronoid process fracture, Non-operative management, Closed reduction, Joint stability 221 226 http://jros.iums.ac.ir/browse.php?a_code=A-10-987-5&slc_lang=en&sid=1 Farid Najd Mazhar fnajdmazhar@yahoo.com 10031947532846008238 10031947532846008238 No Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Bushra Zareie 10031947532846008239 10031947532846008239 No Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Omid Mahmoudi Nasab 10031947532846008240 10031947532846008240 No Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Reza Mohammadi 10031947532846008241 10031947532846008241 No Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran. Sajjad Mohammadnab 10031947532846008242 10031947532846008242 No Department of Orthopedic Surgery, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran. Meisam Jafari Kafiabadi meisamjafarikafiabadi@gmail.com 10031947532846008243 10031947532846008243 Yes Department of Orthopedics Surgery, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hooman Shariatzade 10031947532846008244 10031947532846008244 No Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.