A Unique Case of Bilateral Elbow Terrible Triad in a Polytrauma Patient: Associated Challenges in Management

The terrible triad of the elbow-consisting of elbow dislocation, radial head fracture, and coronoid process fracture-is a challenging injury to treat. Bilateral occurrence is exceptionally rare, particularly in polytrauma patients, and presents significant surgical and rehabilitation challenges.

We present a case of a young male who sustained bilateral terrible triad injuries with an associated right both-bone forearm fracture following a fall from a height. On arrival, he was managed as per the advanced trauma life support protocols. Initial management followed a damage control orthopedics strategy, including temporary stabilization and wound care. After 15 days of intensive care unit stabilization, definitive staged procedures were carried out. These included bilateral radial head replacements, coronoid fixation (suture pull-out technique on the left and screw fixation on the right), and open reduction and internal fixation of the forearm. Elbow surgeries were staged due to the patient's general condition and associated injuries. Early rehabilitation was initiated under supervision. At 1-year follow-up, the patient had a good range of motion, radiological union, and excellent functional scores.

This case highlights the importance of early recognition, individualized staged surgical planning, and structured rehabilitation for achieving successful outcomes in rare and complex bilateral terrible triad injuries in polytrauma patients.