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Vol. 54. Issue 6.
Pages 357-362 (November - December 2010)
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Vol. 54. Issue 6.
Pages 357-362 (November - December 2010)
Original article
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Surgical treatment protocol for elbow “terrible triad”
Tratamiento quirúrgico protocolizado de la «tríada terrible» de codo
D. Cecilia López
Corresponding author

Corresponding author.
, L. Suárez Arias, M.A. Porras Moreno, A. Díaz Martín, F. Jara Sánchez, C. Resines Erasun
Orthopaedic Surgery and Traumatology Department, “12 de Octubre” University Hospital, Madrid, Spain
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To analyse the results in patients with the combination of elbow dislocation and fracture of the radial head and the coronoid process (or «terrible triad» of elbow) using a standardised protocol.

Material and methods

A prospective longitudinal study of 24 patients, 10 women and 14 men, median age was 53 years, diagnosed and operated of elbow triad using a standardised protocol The mean follow-up was two years (12–50 months). Treatment included replacement or osteosynthesis of the radial head, repair or osteosynthesis of the coronoid fracture and ligament repair. The results were evaluated clinically using the Mayo scale Elbow Performance Score (MEPS) and radiographically.


The final average mobility was 105° of flexion-extension and 150° of pronosupination. The average score according to the MEPS level was 85 (65–100 points). No patient required re-intervention although there were two complications: one had a superficial infection and in another a residual fragment of the radial head remained that was not removed during surgery.


The treatment for the «terrible triad» of the elbow should maintain a stable joint, preserving or replacing the radial head, repairing the lateral collateral ligament complex, and synthesis of the coronoid fracture.

Radial head

Analizar nuestros resultados en pacientes tratados quirúrgicamente por asociación de luxación de codo con fractura de la cabeza radial y fractura de la apófisis coronoides o «tríada terrible» de codo, con un protocolo estandarizado.

Material y métodos

Estudio longitudinal prospectivo de 24 pacientes, 10 mujeres y 14 hombres, con 53 años de edad media, diagnosticados de tríada de codo e intervenidos de forma protocolizada. El seguimiento medio fue de dos años (12–50 meses). El tratamiento incluye la sustitución u osteosíntesis de la cabeza radial, la reparación u osteosíntesis de la fractura de coronoides y la reparación ligamentosa. Los resultados se valoraron con la escala Mayo Elbow Performance Score (MEPS) y radiográficamente.


La movilidad media final fue de 105° flexo-extensión y 150° de prono-supinación. La puntuación media en la escala MEPS fue de 85 (65–100 puntos). Ningún paciente precisó de reintervención aunque un caso presentó una infección superficial y en otro persistió un fragmento residual de la cabeza radial que no se extirpó durante la cirugía.


El tratamiento recomendado en la tríada terrible de codo debe mantener una articulación estable, preservando o sustituyendo la cabeza radial, reparando el complejo del ligamento lateral externo e intentando sintetizar la fractura de la coronoides.

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