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Related Experiment Video

Updated: Jun 25, 2026

Novel Triple-Loop Technique for Suturing TFCC Injuries without Transosseous Tunnel

Novel Triple-Loop Technique for Suturing TFCC Injuries without Transosseous Tunnel

Published on: May 23, 2025

Complex varus elbow instability: a terrible triad model.

Stephen E Fern¹, John R Owen, Nicholas J Ordyna

¹Department of Orthopaedic Surgery and Biomedical Engineering, Orthopaedic Research Laboratory, Virginia Commonwealth University, Richmond, VA 23298-0694, USA.

Journal of Shoulder and Elbow Surgery

|February 17, 2009

Summary

This summary is machine-generated.

Aggressive treatment of coronoid fractures is crucial for elbow stability in terrible triad injuries. Even with LCL repair and radial head replacement, severe coronoid loss compromises varus stability.

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Last Updated: Jun 25, 2026

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Published on: May 23, 2025

Area of Science:

Orthopedic Surgery
Biomechanics
Trauma Research

Background:

The terrible triad involves elbow dislocation with lateral collateral ligament (LCL) complex, radial head, and coronoid process injury.
Understanding the contribution of each component to elbow stability is critical for effective treatment.

Purpose of the Study:

To investigate the role of the lateral collateral ligament (LCL) complex, radial head, and coronoid process in elbow varus stability.
To determine the impact of varying degrees of coronoid process loss on elbow stability following injury and repair.

Main Methods:

Utilized 10 fresh-frozen cadaveric upper extremities for biomechanical testing.
Assessed varus stability under intact, LCL deficient/repaired, and radial head resected/replaced conditions at different flexion angles and coronoid resection levels.
Measured restraining load at 1.5 cm varus displacement using a materials testing machine.

Main Results:

Loss of >50% of the coronoid process significantly impacted varus stability.
Neither isolated LCL repair nor isolated radial head replacement significantly improved stability beyond 50% coronoid loss.
Combined LCL repair and radial head replacement showed improved stability for 67-75% coronoid loss, but not for >75% loss.

Conclusions:

These findings support aggressive surgical management of coronoid process fractures in terrible triad injuries.
Significant coronoid loss compromises elbow varus stability, even with concurrent LCL and radial head reconstruction.