Is it a Monteggia-like fracture or an associated variant of the terrible triad? An unusual complex elbow fracture-dislocation (case report).

Terrible triad injuries and Monteggia fracture-dislocations of the elbow are two complex injuries with distinct mechanisms of injury, both having the potential to lead to long-term complications. Depending on the energy of the injury mechanism they can be associated with other lesions. We report a very rare, intriguing case of a complex fracture-dislocation of the elbow, which could be classified as a variant of the terrible triad or a Monteggia-like lesion. A 43-year-old male presented a complex fracture-dislocation of the right elbow, including a diaphyseal ulnar fracture, coronoid fracture, and multifragmentary radial head fracture-dislocation. Surgical intervention involved coronoid fixation after excision of radial head fragments, diaphyseal ulnar fixation, radial head arthroplasty, and lateral collateral ligament repair. At follow-up, the patient has a stable, pain-free elbow, resuming daily activities six months post-surgery. The analysis of injury mechanisms and lesion patterns is fundamental to establishing an effective surgical therapeutic strategy tailored to the nature of the fracture. A good functional outcome is only guaranteed if a congruent and stable joint is restored.