Aceh — A new systematic review suggests that not all terrible triad elbow injuries require surgery. In selected stable cases, conservative treatment after closed reduction may provide favorable outcomes without surgical intervention. The study was conducted by Saidil Mursalin from Universitas Abulyatama Aceh and published in the East Asian Journal of Multidisciplinary Research in 2026. The findings may reshape how orthopedic specialists approach one of the most complex elbow injuries.
Terrible triad elbow injuries involve a combination of elbow dislocation, radial head fracture, and coronoid process fracture. For decades, these injuries have been considered highly unstable and traditionally treated with surgery due to the risk of chronic instability, stiffness, pain, and post-traumatic arthritis.
Surgical intervention has long been the standard because it allows doctors to restore joint stability and initiate early motion. However, surgery also carries risks such as infection, nerve injury, stiffness, hardware complications, and repeat procedures.
To examine whether surgery is always necessary, Saidil Mursalin reviewed existing global evidence on nonoperative treatment in stable cases. His review analyzed studies from PubMed, Cochrane Library, and ScienceDirect.
Out of 560 identified studies, only five met the inclusion criteria. These studies involved 83 adult patients treated conservatively after successful closed reduction. The review process followed strict screening standards, as shown in the PRISMA flowchart presented in the article.
The findings were promising. Most patients maintained stable elbows and regained functional motion. Final elbow flexion ranged between 128° and 134°, enough for most daily activities.
Functional recovery scores were also high. Several studies reported Mayo Elbow Performance Scores between 94 and 95, while 77 percent of patients in the largest study achieved good to excellent outcomes.
According to Mursalin, patient selection is the most critical factor. Nonoperative treatment works best when the elbow remains properly aligned after reduction, without mechanical blockage during movement, and when fractures are small and stable.
The study also highlights that conservative care does not mean “risk-free.” Around 13 percent of patients eventually needed delayed surgery due to recurrent instability, stiffness, or abnormal bone growth.
Other complications included clicking sounds during motion, limited forearm rotation, and mild degenerative changes. Still, many of these did not significantly affect daily function.
The findings could influence clinical decision-making worldwide. For selected patients, especially those with comorbidities or high anesthesia risk, avoiding surgery may offer safer and more cost-effective treatment.
Mursalin argues that future orthopedic care should focus more on post-reduction stability rather than relying solely on injury labels. This personalized approach may improve outcomes while reducing unnecessary surgeries.
The study reinforces an evolving orthopedic principle: in some cases, preserving functional stability may matter more than aggressively repairing every injured structure.
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