non-operative management of terrible triad injuries of the elbow: a case series

Background: 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. objectives: this study evaluates the outcomes of non-operative management in 17 patients with tt injuries treated between 2015 and 2023.methods: 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.results: the mean follow-up period was 53.24 months (range: 26-96 months). the mean mepi score was 95.29±6.95, and the mean dash score was 5.64±4.06. the mean rom for the affected elbow was 9.71±5.72 degrees in extension, 130.6±8.27 degrees in flexion, 65.29±10.07 degrees in supination, and 59.71±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.conclusion: 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.