Internal brace augmentation for lateral ulnar collateral ligament repair in terrible triad injury

Background: To evaluate the clinical and functional outcomes of lateral ulnar collateral ligament (LUCL) repair augmented with the internal brace technique in patients with terrible triad injuries (TTI) of the elbow. Methods: We retrospectively reviewed 17 elbows (16 patients) with TTI treated at a single tertiary medical center between 2022 and 2025. Surgical management followed a standardized protocol: coronoid process fixation via the suture lasso technique, radial head reconstruction (ORIF) or replacement, and LUCL repair augmented with high-strength suture tape (internal brace). An accelerated rehabilitation protocol using alternating splints (full extension and 90∘ flexion) was initiated on the first postoperative day (POD 1). Clinical outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and range of motion (ROM) at a minimum follow-up of one year. Results: The mean patient age was 47.3 years. At the final follow-up, the average elbow flexion/extension arc was 137.65∘±22.16∘ and the pronation/supination arc was 158.83∘±32.04∘. The mean MEPS was 95.88 ± 10.49, indicating excellent functional results. Complications occurred in 3 elbows (17.6%): two cases of transient posterior interosseous nerve palsy that resolved spontaneously and one case of heterotopic ossification requiring surgical excision. No instances of recurrent instability or hardware failure were observed. Conclusions: LUCL repair with internal brace augmentation appears to provide sufficient immediate stability in TTI, facilitating the initiation of an accelerated postoperative rehabilitation protocol. This approach is associated with excellent functional outcomes and high patient-reported scores while minimizing the risk of postoperative stiffness.