Radial head replacement or repair for the terrible triad of the elbow: which procedure is better?

Background The terrible triad of the elbow comprises an ulnar coronoid process fracture, a radial head ( RH ) fracture and posterior dislocation of the elbow. It is considered severe by many clinicians because it is difficult to repair and has a poor prognosis; therefore, it deserves more attention. Methods Thirty‐nine patients with terrible triad of the elbow characterized by a M ason type‐ III RH fracture were randomly divided into either an RH repair group ( n = 19) or an RH replacement group ( n = 20). The complication rates, radiological outcomes, M ayo E lbow P erformance S core and range of motion of the elbow were analysed. Results Follow‐up demonstrated no subluxation or recurrent dislocation of the elbow. Differences in surgery duration between the groups were significant ( P < 0.001). The outcomes in terms of M ayo E lbow P erformance S core ( P = 0.009), flexion–extension arc ( P = 0.01) and pronation–supination arc ( P = 0.04) were significantly better in the RH replacement group. In addition, patients in the RH replacement group displayed significantly fewer post‐surgery complications than those in the RH repair group ( P = 0.04). Conclusion Treating M ason type‐ III RH fracture in a terrible triad of the elbow with a metal RH prosthesis resulted in better clinical outcomes and fewer post‐surgery complications than treating a terrible triad of the elbow by repairing it with screws or plates. RH replacement might be a more effective approach to better managing a terrible triad of the elbow.