- Asses if the injured extremity is neurovascularly intact; if not, immediate reduction and surgical consultation are needed.
- Assess for signs of compartment syndrome. If present, emergency fasciotomy is needed.
- Pain control (reasonable use of narcotics).
- Nothing by mouth (NPO).
The terrible triad injury is a complex dislocation (dislocation with concomitant bony injury) of the elbow. Terrible triad injury includes a posterior elbow dislocation accompanied by a fracture of the radial head or neck and of the coronoid process of the ulna.
Causes / typical injury mechanism: Terrible triad injury is an acute injury. The most common mechanism of action is a fall on an outstretched hand (FOOSH), creating an axial load with mild elbow flexion, internal rotation of the humerus with valgus stress, and forearm supination. High-energy trauma can also lead to terrible triad but is less common than FOOSH.
Classic history and presentation:
- High-impact sport injuries
- Falls from height
- High-impact trauma
- Terrible triad injuries account for 10%-11% of all adult elbow fractures.
- No known differences in sex prevalence.
- Elbow injuries are more common in the elderly population.
- They are less common in the pediatric population.
- Up to 20% of elbow dislocations result in a concomitant fracture.
Grade / classification system:
- Ulnohumeral joint dislocation.
- Radial head or neck fracture.
- Coronoid fracture of ulna. Smaller fracture fragments off of the coronoid are more likely to be associated with terrible triad injuries.