Background: The “terrible triad injury of the elbow" is complex fracture dislocation injury comprising a notorious combination of elbow dislocation and fractures of the coronoid process and radial head.
Objectives: The work aimed to demonstrate the results of radial head prosthetic replacement in management of fracture head of radius in terrible triad injury of the elbow in terms of clinical and radiological outcomes.
Patients and methods: This is a retrospective study that includes 20 patients that fulfilled inclusion criteria, presented with terrible triad injury of the elbow to Qena University Hospital trauma unit in the period between July 2018 and August 2022, managed with prosthetic replacement of the radial head using non-modular metal spacer and reconstruction of elbow ligaments.
Results: We found that most patients (18 patients, 90%) reported return to previous work and daily activity, at  least14 patients (70%) reported good functional ROM in their last follow-up with mean MEPS and QuickDASH scores 76 and 37.09 points, respectively. On the other hand, there was a high rate of complications. Most significantly,  two patients (10%) experienced residual valgus instability. Another two (10%) patients demonstrated heterotrophic calcification. Four (20%) patients suffered nerve injury.
Conclusion: Current surgical protocols made it possible to achieve acceptable outcome and regain the joint function using economically affordable, cost-effective, non-modular prosthesis. However, there is still significant risk of long-term disability and high rate of complications.