Surgical Outcomes of Terrible Triad Injuries of the Elbow in a Resource-Limited Setting: A Consecutive Case Series.

PURPOSE: To evaluate surgical outcomes of acute terrible triad injuries of the elbow treated without radial head prostheses or hinged external fixation and to identify factors associated with recovery in a resource-limited setting.

METHODS: We retrospectively reviewed 30 of 151 eligible adults treated surgically between January 2021 and June 2024 at a tertiary trauma center in Vietnam. Mean follow-up was 13.9 ± 8.9 months. Outcomes included Mayo Elbow Performance Score (MEPS), Subjective Elbow Value, range of motion, radiographic findings, instability, and complications. Radial head fixation was performed in 66.7%, excision in 13.3%, coronoid fixation in 80%, lateral collateral ligament repair in 73.3%, and medial collateral ligament (MCL) repair in 33.3%.

RESULTS: Mean MEPS was 81.2 ± 13.9, with 76.7% achieving good-to-excellent outcomes. Overall instability occurred in 40%, while concentric reduction was maintained in 73.3% and subluxation occurred in 26.7%. Radial head nonunion occurred in 15% of fixation cases. Radial head excision without MCL repair was associated with increased valgus carrying angle, while supervised physiotherapy was associated with a smaller extension deficit. No deep infections or reoperations were recorded. However, 3 of 18 patients treated with trans-humeral K-wires (16.7%) sustained iatrogenic olecranon fractures. Radiographic arthritis occurred in 50%.

CONCLUSIONS: Acceptable short-term functional outcomes can be achieved despite limited implant availability, but instability and radiographic complications remain substantial. Given the 19.9% follow-up rate, findings should be interpreted cautiously because of potential selection bias. Radial head preservation and MCL repair when excision is unavoidable are recommended, while trans-humeral K-wire stabilization should be used selectively.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.