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.