Traumatic bilateral terrible triad of elbow with left trans Scaphoid peri-lunate dislocation and right Lunate dislocation

Introduction: Posterior dislocation of the elbow joint with fracture of both the radial head and coronoid process, the so called ‘terrible triad’, is a complex and difficult-to-treat injury. We present a rare case of Bilateral terrible triad of elbow associated with left peri-lunate dislocation and right lunate dislocation never reported in the literature. Case report: A 38 year old male presented to our hospital after a road traffic accident with fall on outstretched hand, complaining of pain in both elbows and wrist. There were no external injuries at the time of presentation. On clinical examination, there was instability of both elbows. There was swelling over both elbows and wrists. No neurovascular deficit noted. Radiological examination revealed terrible triad of both elbows, left trans-scaphoid peri-lunate dislocation with right lunate dislocation. Confirmed with CT scan. Under sedation, closed reduction tried. Right lunate reduced and was stable. Left lunate and both elbows were irreducible. So patient was posted for surgical management under GA with a single posterior incision. Patient was started on Tablet Indomethacin 25mg TID for 3 weeks. After 3 weeks, K-wires of left wrist removed, wrist and elbow mobilization started. After 6 months of follow up, patient has 20-1000 elbow range of motion with 0-70 0 pronation and supination. Patient is able to do all his daily routine activities without any difficulty. Conclusion: Terrible triad of elbow is one of the difficult to deal with injuries around elbow. CT scan is must to understand the pattern of injury. Meticulous repair of bony-capsular complex gives good results and prevent instability.