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:: Volume 28, Issue 1 (3-2026) ::
J Gorgan Univ Med Sci 2026, 28(1): 86-92 Back to browse issues page
Non-Surgical Treatment of an Unstable Terrible Triad Injury of the Elbow: A Case Report
Saeed Kokly *
Associate Professor of Orthopaedics, Golestan Rheumatology Research Center, School of Medicine, Golestan University of Medical Sciences, Gorgan, Iran. , skokly@gmail.com
Abstract:   (3302 Views)

The terrible triad of the elbow consists of an elbow joint dislocation (ulnohumeroradial and radiocapitellar), a fracture of the radial head or neck, and a fracture of the coronoid process. Since these injuries are highly prone to persistent pain, poor painful functional outcomes, and common complications—including instability, elbow stiffness, and osteoarthritis—their treatment is predominantly surgical to achieve stability and initiate early mobilization. However, non-surgical treatment may occasionally be appropriate in carefully selected, compliant patients under close clinical and radiographic surveillance. The present study reports a case of an unstable terrible triad of the elbow that was initially a candidate for surgery. However, due to the patient's cardiomyopathy, following initial reduction in the operating room, a long arm splint was applied at 100 degrees of flexion because of instability and re-dislocation. The patient was prescribed Indomethacin 25 mg 2–3 times daily, along with Omeprazole. On the first postoperative day, finger movements and isometric contractions of the forearm and arm muscles were instructed. The splint was removed after 2 weeks, and a splint at 90 degrees of elbow flexion stopping proximal to the wrist was applied until the end of the 6th week. Upon observing satisfactory radiographs at a 45 degrees angle, active motion was permitted from full flexion to 45 degrees of flexion. After 4 weeks, following acceptable radiographs at 30 degrees of flexion, motion was allowed from full flexion to 30 degrees of flexion. At the 6-month follow-up, the patient was satisfied and demonstrated healing of the radial neck fracture. The coronoid process fracture healed via fibrous union but remained asymptomatic. There was no evidence of elbow osteoarthritis, ulnar neuropathy, or heterotopic ossification. The patient exhibited a 20 degrees elbow flexion contracture.
 

Keywords: Elbow [MeSH], Joint Instability [MeSH], Terrible Triad of the Elbow , Conservative Treatment [MeSH]
Article ID: Vol28-10
Full-Text [PDF 724 kb]   (1837 Downloads) |   |   Abstract (HTML)  (307 Views)  
Type of Study: Case Report | Subject: Orthopaedics
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Kokly S. Non-Surgical Treatment of an Unstable Terrible Triad Injury of the Elbow: A Case Report. J Gorgan Univ Med Sci 2026; 28 (1) :86-92
URL: http://goums.ac.ir/journal/article-1-4674-en.html


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Volume 28, Issue 1 (3-2026) Back to browse issues page
مجله دانشگاه علوم پزشکی گرگان Journal of Gorgan University of Medical Sciences
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