ABSTRACT Background: Complex elbow dislocations are injuries in which there is a significant risk of long-term disability. The combination of elbow dislocation with both radial head and coronoid process fracture is particularly challenging to treat and, as such, has been termed terrible triad injury (TTI) of the elbow. TTI is typically caused by high-energy falls onto an outstretched hand. Case report: A-48-years-old male patient, not known to have any medical illnesses, presented to Emergency Department Orthopedic, King Fahad General Hospital, complaining of right elbow, forearm and wrist pain and deformities after history of fall down directly to his right hyperflexed wrist and extended elbow that resulted in elbow dislocation and ipsilateral transscaphoid perilunate fracture dislocation. Management: Patient was shifted to operation room for open reduction internal fixation. We started with elbow through posterior elbow approach, coronoid reduced that was fixed by two interfragmentry screws. Then for olecranon fracture, through same posterior incision, ulnar nerve was identified and protected and fracture was reduced and fixed with anatomical plate. Elbow stability was checked where it was stable. Then, distal radius open reduction through dorsal approach and internal fixation with LC-DCP was achieved. Additionally, through dorsal approach, lunate dislocation and scaphoid fracture were reduced and fixed with 6 k-wires and spaning external fixator applied from radius to 2nd metacarpal to maintain reduction. Conclusion: In case of right terrible triad injury of the elbow with ipsilateral trans-scaphoid perilunate fracture dislocation, only urgent surgical treatment of both elbow and wrist may achieve good results.