Bilateral Terrible Triad of the Elbow Associated with an Olecranon Fracture: A Rare Case and Therapeutic Challenge

Introduction: The terrible triad of the elbow (TTE) is a complex injury combining a radial head fracture, a coronoid process fracture, and a posterior elbow dislocation. Its bilateral occurrence is exceptional. We report an original case of bilateral TTE complicated by an olecranon fracture on the dominant side, to analyze the specificities of its management.

Case Report: A 34-year-old man, right-handed, with no significant medical history, was the victim of a 7-meter fall. Radiological assessment revealed a bilateral TTE (Regan-Morrey type 3 coronoid fractures and Mason type 3 radial head fractures) associated with a Duparc type 3 olecranon fracture on the right. Surgical management involved a sequential "from the inside out" repair ("Lasso" suture of the left coronoid, osteosynthesis of the radial heads, lateral ligament repair). The right posterior approach allowed for coronoid fixation with a screw and olecranon fixation with a plate, along with ligament repair.

Discussion: This case, one of the few described of bilateral TTE with an olecranon fracture, results from high-energy trauma. The therapeutic strategy follows established principles: anatomical repair of bony structures (prioritizing the coronoid and radial head), systematic stabilization of the lateral ligament complex, and early mobilization. The choice of techniques (suture vs. screw for the coronoid, osteosynthesis vs. radial head arthroplasty) must be adapted to the fracture type and patient profile.

Conclusion: Bilateral TTE is a rare entity that requires meticulous and individualized surgical planning. Robust anatomical repair and early rehabilitation are key to optimizing functional outcomes and minimizing the risk of stiffness and osteoarthritis.